Provider Demographics
NPI:1922826981
Name:HART, EMILY HEMBRUCH (MS, BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:HEMBRUCH
Last Name:HART
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5960 GETWELL RD STE 212D
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-7320
Mailing Address - Country:US
Mailing Address - Phone:618-604-7236
Mailing Address - Fax:678-868-2843
Practice Address - Street 1:5960 GETWELL RD STE 212D
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-7320
Practice Address - Country:US
Practice Address - Phone:662-228-0130
Practice Address - Fax:678-868-2843
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS241029103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst