Provider Demographics
NPI:1124303318
Name:COLEMAN, KINDRA DANIELLE (MED, BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:KINDRA
Middle Name:DANIELLE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8408 BURRELL DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7828
Mailing Address - Country:US
Mailing Address - Phone:512-217-5913
Mailing Address - Fax:
Practice Address - Street 1:11718 METRIC BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-3203
Practice Address - Country:US
Practice Address - Phone:512-265-3615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-11-8453103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst