Healthcare Provider Details

I. General information

NPI: 1891201935
Provider Name (Legal Business Name): SYDNEY KATHERINE WHITE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MARY LOU DR
WILLOW PARK TX
76087-8746
US

IV. Provider business mailing address

408 VERNA TRL N
FORT WORTH TX
76108-4301
US

V. Phone/Fax

Practice location:
  • Phone: 682-267-5018
  • Fax:
Mailing address:
  • Phone: 817-925-4890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-28453
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: