Provider Demographics
NPI:1447598255
Name:BEAUDREAULT, KRIS (LBA, BCBA)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:BEAUDREAULT
Suffix:
Gender:F
Credentials:LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 ATTWATER WAY
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-7775
Mailing Address - Country:US
Mailing Address - Phone:413-552-6648
Mailing Address - Fax:
Practice Address - Street 1:1325 SPACE PARK DR STE B&C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3459
Practice Address - Country:US
Practice Address - Phone:713-355-0623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-8877103K00000X
TX2460103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst