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NPI Code Detail

MEDICARE: KYLYNN COULOMBE BCBA

MEDICARE: KYLYNN COULOMBE BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2103K00000XBehavior Analyst1-23-69831MI

General Provider Information

NPI Number : 1053015503
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLYNN COULOMBE BCBA
Provider Business Mailing Address
First Line : 215 RED COACH DR
Second Line :
City : MISHAWAKA
State : IN
Zip : 46545-8307
Country : US
Telephone Number : 574-387-4313
Fax Number :
Provider Business Practice Location Address
First Line : 3744 GULL RD
Second Line :
City : KALAMAZOO
State : MI
Zip : 49048-7642
Country : US
Telephone Number : 574-387-4313
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2023
Last Update Date : 01/09/2025

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