Provider Demographics
NPI:1689818569
Name:VANKIRK, TESSA SCHREIBER (BCBA)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:SCHREIBER
Last Name:VANKIRK
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 1:5104 SEALANDS LN
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-8416
Mailing Address - Country:US
Mailing Address - Phone:940-367-4979
Mailing Address - Fax:469-779-7133
Practice Address - Street 1:8100 LOMO ALTO DR STE 125
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5897
Practice Address - Country:US
Practice Address - Phone:940-367-4979
Practice Address - Fax:469-779-7133
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
1-04-1547103K00000X
TX1483103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst