Provider Demographics
NPI:1578262242
Name:GILLINGS, KATHERINE (BCABA LAABA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:GILLINGS
Suffix:
Gender:F
Credentials:BCABA LAABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 TX 31
Mailing Address - Street 2:
Mailing Address - City:MURCHISON
Mailing Address - State:TX
Mailing Address - Zip Code:75778
Mailing Address - Country:US
Mailing Address - Phone:949-885-6289
Mailing Address - Fax:
Practice Address - Street 1:10101 TX 31
Practice Address - Street 2:
Practice Address - City:MURCHISON
Practice Address - State:TX
Practice Address - Zip Code:75778
Practice Address - Country:US
Practice Address - Phone:949-885-6289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0-20-10898103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst