Healthcare Provider Details

I. General information

NPI: 1740828409
Provider Name (Legal Business Name): KASSANDRA LYNN CAIN MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16538 N MAY AVE
EDMOND OK
73012-9007
US

IV. Provider business mailing address

1012 NW GRAND BLVD
OKLAHOMA CITY OK
73118-6000
US

V. Phone/Fax

Practice location:
  • Phone: 405-265-9208
  • Fax:
Mailing address:
  • Phone: 405-594-8336
  • Fax: 832-383-5347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-50405
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: