Healthcare Provider Details

I. General information

NPI: 1730645110
Provider Name (Legal Business Name): KAITLYN RUBIN HARRIS ME.D, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN ELIZABETH RUBIN ME.D, BCBA, LBA

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 SOUTHWEST BLVD
BENBROOK TX
76132-1080
US

IV. Provider business mailing address

6211 SOUTHWEST BLVD
BENBROOK TX
76132-1080
US

V. Phone/Fax

Practice location:
  • Phone: 817-249-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11829821
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: