Provider Demographics
NPI:1053175398
Name:MEREDITH, KAYLA MARIE (BCBA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 RIO ANCHO BLVD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-3568
Mailing Address - Country:US
Mailing Address - Phone:512-696-0284
Mailing Address - Fax:
Practice Address - Street 1:731 N WALNUT AVE
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-7927
Practice Address - Country:US
Practice Address - Phone:830-507-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-24-70800103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst