Provider Demographics
NPI:1073076261
Name:ELLIOTT, KRISTINA M (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 COUNTY ROAD 358
Mailing Address - Street 2:
Mailing Address - City:GAUSE
Mailing Address - State:TX
Mailing Address - Zip Code:77857-7148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:592 COUNTY ROAD 358
Practice Address - Street 2:
Practice Address - City:GAUSE
Practice Address - State:TX
Practice Address - Zip Code:77857-7148
Practice Address - Country:US
Practice Address - Phone:513-369-3920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-13
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2664103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst