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NPI Code Detail

MEDICARE: KILEY HENDERSON BCBA

MEDICARE: KILEY HENDERSON BCBA
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
1106E00000XAssistant Behavior Analyst
2103K00000XBehavior AnalystFL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902572944
Entity Type Code : Individual
Provider Name (Legal Business Name) : KILEY HENDERSON BCBA
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 463-223-4591
Fax Number :
Provider Business Practice Location Address
First Line : 3600 MACLAY BLVD S STE 100
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32312-1276
Country : US
Telephone Number : 850-333-1279
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2021
Last Update Date : 08/10/2023

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