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NPI Code Detail

MEDICARE: KALEIDOSCOPE BEHAVIOR SERVICES

MEDICARE: KALEIDOSCOPE BEHAVIOR SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11821542473OTHERNPI1

General Provider Information

NPI Number : 1790456937
Entity Type Code : Organization
Provider Name (Legal Business Name) : KALEIDOSCOPE BEHAVIOR SERVICES
Provider Business Mailing Address
First Line : 4908 RANDEE CIR
Second Line :
City : PENSACOLA
State : FL
Zip : 32526-2054
Country : US
Telephone Number : 985-413-8127
Fax Number :
Provider Business Practice Location Address
First Line : 4908 RANDEE CIR
Second Line :
City : PENSACOLA
State : FL
Zip : 32526-2054
Country : US
Telephone Number : 985-413-8127
Fax Number :
Authorized Official
Title or Position : OWNER
Name : KELLY LYNN WHITE
Credential : BCBA
Telephone Number : 985-413-8127
Provider Enumeration Date : 09/27/2021
Last Update Date : 09/27/2021

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Directions to “KALEIDOSCOPE BEHAVIOR SERVICES ” Practice Location

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