MEDICARE: KRISTIN RENEE BARRAZA BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1386836831	OTHER	TX	ABA

General Provider Information

NPI Number	:	1063939205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN RENEE BARRAZA BCBA

Provider Business Mailing Address
First Line	:	5109 E 5TH ST
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77493-2117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5109 E 5TH ST
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77493-2117
Country	:	US
Telephone Number	:	832-622-8164
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2017
Last Update Date	:	04/05/2022

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