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General NPI Number Information
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NPI Number | 1215825567
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Entity Type | Individual
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Provider Name | KYLEE GLENN
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Gender |
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 245 S PRESTON RD STE 110
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City | CELINA
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State | TX
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Zip | 75009-3420
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Country | US
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Telephone | 877-772-7889
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 CANADIAN RIVER DR
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City | PROSPER
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State | TX
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Zip | 75078-2223
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Country | US
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Telephone | 636-248-3211
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Fax | 636-248-3211
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 12582064
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License Number State | TX
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