Provider Demographics
NPI:1811576499
Name:FATINO, TINA (RBT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:FATINO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 NE BARRY RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2722
Mailing Address - Country:US
Mailing Address - Phone:816-368-8120
Mailing Address - Fax:800-687-5070
Practice Address - Street 1:1337 S FOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7205
Practice Address - Country:US
Practice Address - Phone:816-368-8120
Practice Address - Fax:800-687-5070
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORBT-19-102800106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician