MEDICARE: CRISTINA T VANARSDALL BCABA

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	0-20-10950	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	752797339	OTHER	TX	BEHAVORIAL HEALTH

General Provider Information

NPI Number	:	1457986077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA T VANARSDALL BCABA

Provider Business Mailing Address
First Line	:	4084 REGENT DR
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-1508
Country	:	US
Telephone Number	:	940-228-5297
Fax Number	:	940-500-4025

Provider Business Practice Location Address
First Line	:	4084 REGENT DR
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-1508
Country	:	US
Telephone Number	:	940-228-5297
Fax Number	:	940-500-4025

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

Provider Enumeration Date	:	03/04/2020
Last Update Date	:	03/04/2020

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