Provider Demographics
NPI:1760896377
Name:COSTA, KATHERINE (SPSYS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:COSTA
Suffix:
Gender:F
Credentials:SPSYS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 LYON ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3715
Mailing Address - Country:US
Mailing Address - Phone:616-460-7735
Mailing Address - Fax:
Practice Address - Street 1:1607 LYON ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3715
Practice Address - Country:US
Practice Address - Phone:616-460-7735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171400000XOther Service ProvidersHealth & Wellness Coach