Provider Demographics
NPI:1588081731
Name:CHILDS PATH
Entity type:Organization
Organization Name:CHILDS PATH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:214-681-0344
Mailing Address - Street 1:PO BOX 864557
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75086-4557
Mailing Address - Country:US
Mailing Address - Phone:214-681-0344
Mailing Address - Fax:214-291-5692
Practice Address - Street 1:8720 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-3079
Practice Address - Country:US
Practice Address - Phone:214-681-0344
Practice Address - Fax:214-291-5692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-12-12040103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0002BFOtherBCBS
TX12347082668OtherTRICARE
TX1316338544OtherNPI
TX1720332117OtherINDIVIDUAL NPI
TX1851718209OtherNPI
TX3639503OtherUNITED HEALTH CARE