Provider Demographics
NPI:1003503590
Name:TRUMAN, KRISTIN RAE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:RAE
Last Name:TRUMAN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10335 CROSS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2795
Mailing Address - Country:US
Mailing Address - Phone:813-406-4452
Mailing Address - Fax:
Practice Address - Street 1:10335 CROSS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2795
Practice Address - Country:US
Practice Address - Phone:813-406-4452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-22-61163103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst