Provider Demographics
NPI:1669936043
Name:ALVAREZ, KRISTINA MARIE (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials: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:PO BOX 151716
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78715-1716
Mailing Address - Country:US
Mailing Address - Phone:512-898-9044
Mailing Address - Fax:512-857-1423
Practice Address - Street 1:2301 S BAGDAD RD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78641-2309
Practice Address - Country:US
Practice Address - Phone:512-898-9044
Practice Address - Fax:512-857-1423
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2670103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14397411OtherCAQH
TX2670OtherLBA
TX1-18-33087OtherBCBA