Provider Demographics
NPI:1912385956
Name:MCRAE, KEVIN (MA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MCRAE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2499 S CAPITAL OF TEXAS HWY
Mailing Address - Street 2:BUILDING B SUITE B202
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7762
Mailing Address - Country:US
Mailing Address - Phone:512-699-4589
Mailing Address - Fax:817-382-4850
Practice Address - Street 1:3100 PREMIER DR
Practice Address - Street 2:234
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2661
Practice Address - Country:US
Practice Address - Phone:972-755-1222
Practice Address - Fax:817-382-4850
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-15-17941103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst