Provider Demographics
NPI:1922674092
Name:TERRELL, KATY RAE (MS, BCBA, LBA)
Entity Type:Individual
Prefix:MISS
First Name:KATY
Middle Name:RAE
Last Name:TERRELL
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7485 PHELAN BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-5748
Mailing Address - Country:US
Mailing Address - Phone:409-842-9898
Mailing Address - Fax:
Practice Address - Street 1:7485 PHELAN BLVD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-5748
Practice Address - Country:US
Practice Address - Phone:409-842-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X, 106E00000X
TX5602103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXRBT-21-158432OtherREGISTERED BEHAVIOR TECHNICIAN