Provider Demographics
NPI:1649079385
Name:DANIELS DEERING, KTANNA AUSTIDAWN
Entity type:Individual
Prefix:
First Name:KTANNA
Middle Name:AUSTIDAWN
Last Name:DANIELS DEERING
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 INDIAN TRL STE 140
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-5702
Mailing Address - Country:US
Mailing Address - Phone:254-213-2952
Mailing Address - Fax:
Practice Address - Street 1:716 INDIAN TRL STE 140
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-5702
Practice Address - Country:US
Practice Address - Phone:254-368-4912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-364805106S00000X
TXRBT24364805106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst