Provider Demographics
NPI:1205181823
Name:WHITE, KATHRYN (BCBA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9299 EASTMAN PARK DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-3318
Mailing Address - Country:US
Mailing Address - Phone:832-341-6385
Mailing Address - Fax:
Practice Address - Street 1:9299 EASTMAN PARK DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-3318
Practice Address - Country:US
Practice Address - Phone:970-344-4458
Practice Address - Fax:970-344-4458
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11313669103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst