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NPI Code Detail

MEDICARE: KALLY BERDEAUX BCBA

MEDICARE: KALLY BERDEAUX 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
1103K00000XBehavior Analyst1091TX

General Provider Information

NPI Number : 1891274254
Entity Type Code : Individual
Provider Name (Legal Business Name) : KALLY BERDEAUX BCBA
Provider Business Mailing Address
First Line : 8900 RED BLUFF RD
Second Line :
City : PASADENA
State : TX
Zip : 77507-1145
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2700 BAY AREA BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77058-1002
Country : US
Telephone Number : 281-283-3452
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2018
Last Update Date : 01/11/2022

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