Provider Demographics
NPI:1053667352
Name:BATES, KRISTAL RENEE (BCBA & BCABA)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:RENEE
Last Name:BATES
Suffix:
Gender:F
Credentials:BCBA & BCABA
Other - Prefix:
Other - First Name:KRISTAL
Other - Middle Name:RENEE
Other - Last Name:BAISCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:825 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-2164
Mailing Address - Country:US
Mailing Address - Phone:714-222-4429
Mailing Address - Fax:
Practice Address - Street 1:5870 LONG PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2282
Practice Address - Country:US
Practice Address - Phone:972-521-1350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01-12-5088103K00000X
CA1-14-15662103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst