Provider Demographics
NPI:1720521198
Name:DISNEY, KATE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:DISNEY
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 1:2358 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWIS MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98433-1035
Mailing Address - Country:US
Mailing Address - Phone:757-876-5965
Mailing Address - Fax:
Practice Address - Street 1:2358 S 5TH ST
Practice Address - Street 2:
Practice Address - City:LEWIS MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98433-1035
Practice Address - Country:US
Practice Address - Phone:757-876-5965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-21-48304103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst