Provider Demographics
NPI:1588206007
Name:BOLTON, KADIE ELIZABETH (MA, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:KADIE
Middle Name:ELIZABETH
Last Name:BOLTON
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 RANCHITO PASS
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-3647
Mailing Address - Country:US
Mailing Address - Phone:817-899-4659
Mailing Address - Fax:
Practice Address - Street 1:1652 KELLER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3877
Practice Address - Country:US
Practice Address - Phone:682-291-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4748103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst