Provider Demographics
NPI:1982343430
Name:HEICHEL, KATRINA VICTORIA (MED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:VICTORIA
Last Name:HEICHEL
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5085 W PARK BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-2592
Mailing Address - Country:US
Mailing Address - Phone:469-277-6050
Mailing Address - Fax:
Practice Address - Street 1:5085 W PARK BLVD STE 400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-2592
Practice Address - Country:US
Practice Address - Phone:469-277-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12261196103K00000X
TXRBT-21-177549106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician