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General NPI Number Information
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NPI Number | 1467319574
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Entity Type | Individual
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Provider Name | KARYSSA MYHRES BCBA
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Gender | Female
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Dates
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Enumeration Date | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 6565 E STATE ST
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City | ROCKFORD
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State | IL
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Zip | 61108-2542
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Country | US
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Telephone | 815-401-4999
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Fax |
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Provider Business Mailing Address
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Address Line | 15761 CARBREY AVE
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City | SOUTH BELOIT
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State | IL
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Zip | 61080-1866
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Country | US
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Telephone | 815-401-4999
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Fax |
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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 |
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License Number State | IL
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