MEDICARE: CRYSTAL FERNANDEZ PHD, 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	1-15-19566	TX

General Provider Information

NPI Number	:	1801248109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL FERNANDEZ PHD, BCBA

Provider Business Mailing Address
First Line	:	1601 LAMAR BLVD
Second Line	:	SUITE 214 #1072
City	:	FORT WORTH
State	:	TX
Zip	:	76011-7626
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 E LAMAR BLVD STE 214
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-4464
Country	:	US
Telephone Number	:	817-203-4143
Fax Number	:

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

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	08/21/2025

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