Provider Demographics
NPI:1972004950
Name:TRAN, KIM (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 N TARRANT PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6293
Mailing Address - Country:US
Mailing Address - Phone:682-900-1444
Mailing Address - Fax:682-900-1444
Practice Address - Street 1:5340 N TARRANT PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6293
Practice Address - Country:US
Practice Address - Phone:682-900-1444
Practice Address - Fax:682-900-1444
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-30533103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst