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NPI Code Detail

MEDICARE: KENTUCKY ASSOCIATION FOR BEHAVIOR INTERVENTIONS

MEDICARE: KENTUCKY ASSOCIATION FOR BEHAVIOR INTERVENTIONS
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
1103K00000XBehavior Analyst1-04-2095KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-04-2095OTHERKYBOARD CERTIFIED BEHAVIOR ANALYST

General Provider Information

NPI Number : 1205105467
Entity Type Code : Organization
Provider Name (Legal Business Name) : KENTUCKY ASSOCIATION FOR BEHAVIOR INTERVENTIONS
Provider Business Mailing Address
First Line : 11305 ARBOR WOOD DR
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-4189
Country : US
Telephone Number : 502-417-9830
Fax Number :
Provider Business Practice Location Address
First Line : 3211 GRANT LINE RD
Second Line : SUITE 15
City : NEW ALBANY
State : IN
Zip : 47150-2175
Country : US
Telephone Number : 502-417-9830
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : KEITH HERSH
Credential : MS BCBA LBA
Telephone Number : 502-417-9830
Provider Enumeration Date : 12/17/2011
Last Update Date : 08/15/2012

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Directions to “KENTUCKY ASSOCIATION FOR BEHAVIOR INTERVENTIONS ” Practice Location

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