Healthcare Provider Details

I. General information

NPI: 1700797123
Provider Name (Legal Business Name): KAYLEA REEVES BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 VIKING DR
BOSSIER CITY LA
71111-7511
US

IV. Provider business mailing address

PO BOX 1823
WEST MONROE LA
71294-1823
US

V. Phone/Fax

Practice location:
  • Phone: 318-588-8908
  • Fax: 318-588-8909
Mailing address:
  • Phone: 318-588-8908
  • Fax: 318-588-8909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberC-237
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: