Healthcare Provider Details

I. General information

NPI: 1699095489
Provider Name (Legal Business Name): KELLY LYNNE BIVENS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY LYNNE KAINER BCBA

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 PRUITT RD
SPRING TX
77380-3024
US

IV. Provider business mailing address

18401 TIMBER FOREST DR
HUMBLE TX
77346-2535
US

V. Phone/Fax

Practice location:
  • Phone: 281-610-1987
  • Fax:
Mailing address:
  • Phone: 281-852-0501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1151
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-05-2141
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: