Provider Demographics
NPI:1558848275
Name:EBERHARDT, KRISTINA (BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:EBERHARDT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3568 GERAGHTY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-4701
Mailing Address - Country:US
Mailing Address - Phone:907-374-7001
Mailing Address - Fax:907-374-7008
Practice Address - Street 1:3568 GERAGHTY AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-4701
Practice Address - Country:US
Practice Address - Phone:907-374-7001
Practice Address - Fax:907-374-7008
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
AK221074103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician