Provider Demographics
NPI:1811363369
Name:FATTAL, KATHRYN (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:FATTAL
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N CUERNAVACA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78733-3218
Mailing Address - Country:US
Mailing Address - Phone:512-772-4042
Mailing Address - Fax:512-842-7446
Practice Address - Street 1:900 N CUERNAVACA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78733-3218
Practice Address - Country:US
Practice Address - Phone:512-772-4042
Practice Address - Fax:512-842-7446
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-16442103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst