Provider Demographics
NPI:1972896124
Name:THEISS, KATHY (MA, BCBA)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:
Last Name:THEISS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 CAMPUS CIRCLE DR E
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2712
Mailing Address - Country:US
Mailing Address - Phone:469-374-0700
Mailing Address - Fax:
Practice Address - Street 1:6301 CAMPUS CIRCLE DR E
Practice Address - Street 2:SUITE 100A
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2712
Practice Address - Country:US
Practice Address - Phone:469-374-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst