Healthcare Provider Details

I. General information

NPI: 1649900150
Provider Name (Legal Business Name): KYLEE BROOKE M.S., BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HEWITT RD
HAMMOND LA
70403-6084
US

IV. Provider business mailing address

2033 N HIGHWAY 190 STE 10
COVINGTON LA
70433-8985
US

V. Phone/Fax

Practice location:
  • Phone: 985-590-4549
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-85105
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: