Provider Demographics
NPI:1780128322
Name:WHEATLEY, KRISTIN (MED, BCBA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:WHEATLEY
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 HOT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-2030
Mailing Address - Country:US
Mailing Address - Phone:925-683-6631
Mailing Address - Fax:
Practice Address - Street 1:623 HOT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108-2030
Practice Address - Country:US
Practice Address - Phone:925-683-6631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-13126103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst