Provider Demographics
NPI:1154207744
Name:TULLIS, KATIE MARIE (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:TULLIS
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 REINLI ST APT 215
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-1510
Mailing Address - Country:US
Mailing Address - Phone:937-508-7375
Mailing Address - Fax:
Practice Address - Street 1:1920 E RIVERSIDE DRIVE
Practice Address - Street 2:STE A120 PMB369
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741
Practice Address - Country:US
Practice Address - Phone:512-234-2245
Practice Address - Fax:833-523-2369
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8790103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst