Provider Demographics
NPI:1386162667
Name:SILLIS, KATHERINE HELEN (MT, MED)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:HELEN
Last Name:SILLIS
Suffix:
Gender:F
Credentials:MT, MED
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:HELEN
Other - Last Name:GURECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT, MED
Mailing Address - Street 1:7905 TISDALE DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8414
Mailing Address - Country:US
Mailing Address - Phone:804-523-0825
Mailing Address - Fax:
Practice Address - Street 1:3595 RANCH ROAD 620 S # 220
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-6803
Practice Address - Country:US
Practice Address - Phone:512-772-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-17-25675103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst