Provider Demographics
NPI:1154031409
Name:CENTENO, KARINA
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:CENTENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 W ELM
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TX
Mailing Address - Zip Code:76511-4489
Mailing Address - Country:US
Mailing Address - Phone:512-679-6711
Mailing Address - Fax:
Practice Address - Street 1:5209 DUVAL RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-6614
Practice Address - Country:US
Practice Address - Phone:512-963-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician