Healthcare Provider Details

I. General information

NPI: 1083437230
Provider Name (Legal Business Name): KALIE FICK LYLES ABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SAINT MARY ST
THIBODAUX LA
70301-6527
US

IV. Provider business mailing address

PO BOX 1137
THIBODAUX LA
70302-1137
US

V. Phone/Fax

Practice location:
  • Phone: 985-446-6833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL896
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: