Provider Demographics
NPI:1720332117
Name:BOATMAN, CATHERINE (MS, BCBA,)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:BOATMAN
Suffix:
Gender:F
Credentials:MS, BCBA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 BUNKER HILL CIR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-2924
Mailing Address - Country:US
Mailing Address - Phone:972-596-9407
Mailing Address - Fax:
Practice Address - Street 1:2308 BUNKER HILL CIR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-2924
Practice Address - Country:US
Practice Address - Phone:972-596-9407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-12-12040103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1-12-12040OtherBACB LICENSE