Provider Demographics
NPI:1457134306
Name:GARCIA, KERI ANN (BCBA)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:ANN
Last Name:GARCIA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:ANN
Other - Last Name:HERZOG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:143 DOE RUN DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77320-2088
Mailing Address - Country:US
Mailing Address - Phone:936-668-6046
Mailing Address - Fax:
Practice Address - Street 1:143 DOE RUN DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77320-2088
Practice Address - Country:US
Practice Address - Phone:936-668-6046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5653103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst