Provider Demographics
NPI:1932512837
Name:ALLISON, KRYSTLE S (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTLE
Middle Name:S
Last Name:ALLISON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KRYSTLE
Other - Middle Name:
Other - Last Name:MILBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP-A
Mailing Address - Street 1:3052 S SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3907
Mailing Address - Country:US
Mailing Address - Phone:281-994-9801
Mailing Address - Fax:
Practice Address - Street 1:755 S 11TH ST
Practice Address - Street 2:STE 270
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3732
Practice Address - Country:US
Practice Address - Phone:409-835-0228
Practice Address - Fax:409-835-0151
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX379422355S0801X
TX1-23-69689103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant