=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699566281
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATELYN CAROLL MCLEROY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2025
-----------------------------------------------------
Last Update Date | 05/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5731 HIGHWAY 45 ALT S
-----------------------------------------------------
City | WEST POINT
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39773-0414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-435-5315
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5731 HIGHWAY 45 ALT S
-----------------------------------------------------
City | WEST POINT
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39773-0414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-435-5315
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT-25-422545
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------