Provider Demographics
NPI:1477745875
Name:VANDERTULIP, LEE (BCBA)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:
Last Name:VANDERTULIP
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:LEE
Other - Last Name:VANDERTULIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,BCBA
Mailing Address - Street 1:3100 PREMIER DRIVE
Mailing Address - Street 2:SUITE 234
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3602
Mailing Address - Country:US
Mailing Address - Phone:210-336-1524
Mailing Address - Fax:
Practice Address - Street 1:1401 UNIVERSAL CITY BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3317
Practice Address - Country:US
Practice Address - Phone:210-336-1524
Practice Address - Fax:210-346-0277
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1345103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst