Provider Demographics
NPI:1851932859
Name:HANLEY, KATHERINE (MED BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:HANLEY
Suffix:
Gender:F
Credentials:MED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5521 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-5621
Mailing Address - Country:US
Mailing Address - Phone:469-955-4622
Mailing Address - Fax:
Practice Address - Street 1:8408 STACY RD STE 300
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2422
Practice Address - Country:US
Practice Address - Phone:469-625-2193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-19-37936103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst