Provider Demographics
NPI:1588194609
Name:FLEMISTER, KATRINA RENEE (BCBA)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:RENEE
Last Name:FLEMISTER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:GALVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4537 HERITAGE TRACE PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-8921
Mailing Address - Country:US
Mailing Address - Phone:817-442-0222
Mailing Address - Fax:
Practice Address - Street 1:4537 HERITAGE TRACE PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-8921
Practice Address - Country:US
Practice Address - Phone:817-442-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3209103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst