Healthcare Provider Details

I. General information

NPI: 1265364426
Provider Name (Legal Business Name): KENTUCKIANA ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 PINKNEY DRIVE
LEXINGTON KY
40504
US

IV. Provider business mailing address

1795 ALYSHEBA WAY STE 7202 PMB 974649
LEXINGTON KY
40509
US

V. Phone/Fax

Practice location:
  • Phone: 859-334-0683
  • Fax:
Mailing address:
  • Phone: 859-334-0683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JANE DETOMA
Title or Position: OWNER
Credential: BCBA
Phone: 859-334-0683