Healthcare Provider Details

I. General information

NPI: 1790456937
Provider Name (Legal Business Name): KALEIDOSCOPE BEHAVIOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16150 W MAIN ST
CUT OFF LA
70345-3511
US

IV. Provider business mailing address

16150 W MAIN ST
CUT OFF LA
70345-3511
US

V. Phone/Fax

Practice location:
  • Phone: 985-413-8127
  • Fax: 850-466-0024
Mailing address:
  • Phone: 985-413-8127
  • Fax: 850-466-0024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KELLY LYNN WHITE
Title or Position: OWNER
Credential: BCBA
Phone: 985-413-8127