Healthcare Provider Details

I. General information

NPI: 1669251534
Provider Name (Legal Business Name): KITH & KIN ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 LEWIS ST STE 103 OFC 301
FORT WALTON BEACH FL
32547-3142
US

IV. Provider business mailing address

105 LEWIS ST STE 103 OFC 301
FORT WALTON BEACH FL
32547-3142
US

V. Phone/Fax

Practice location:
  • Phone: 850-273-4706
  • Fax: 239-402-9217
Mailing address:
  • Phone: 850-273-4706
  • Fax: 239-402-9217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY FALCON
Title or Position: CO-OWNER
Credential: BCBA
Phone: 214-215-7949