Healthcare Provider Details

I. General information

NPI: 1710642939
Provider Name (Legal Business Name): RAVEN KILLINGER BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. RAVEN MARIE KILLINGER MILES

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CONCORD AVE STE 185
CONCORD CA
94520-5006
US

IV. Provider business mailing address

15-2714 PAHOA VILLAGE RD STE H1-285
PAHOA HI
96778-9715
US

V. Phone/Fax

Practice location:
  • Phone: 475-227-6396
  • Fax:
Mailing address:
  • Phone: 855-832-6727
  • Fax: 772-675-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-77394
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: