Healthcare Provider Details

I. General information

NPI: 1003726068
Provider Name (Legal Business Name): LILAC N KENNEDY M.A.,BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 BRITTMOORE RD
HOUSTON TX
77043-5034
US

IV. Provider business mailing address

1155 BRITTMOORE RD
HOUSTON TX
77043-5034
US

V. Phone/Fax

Practice location:
  • Phone: 713-932-0074
  • Fax: 346-348-1155
Mailing address:
  • Phone: 713-932-0074
  • Fax: 346-348-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBHV-011024
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: