Provider Demographics
NPI:1083210066
Name:GRAS, PAULA KATHRYN
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:KATHRYN
Last Name:GRAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11832 TOBLER TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-6848
Mailing Address - Country:US
Mailing Address - Phone:562-455-6753
Mailing Address - Fax:
Practice Address - Street 1:11832 TOBLER TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-6848
Practice Address - Country:US
Practice Address - Phone:562-455-6753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3771103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX435873102Medicaid