Provider Demographics
NPI:1568957751
Name:GITTINS, KATRINA EVA (BCBA)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:EVA
Last Name:GITTINS
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 1:5501 ROSENA TRL
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-4329
Mailing Address - Country:US
Mailing Address - Phone:469-371-3611
Mailing Address - Fax:
Practice Address - Street 1:5501 ROSENA TRL
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-4329
Practice Address - Country:US
Practice Address - Phone:469-371-3611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-18-30977103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty