Provider Demographics
NPI:1679134043
Name:KIDD'S KIDS ABA THERAPY
Entity type:Organization
Organization Name:KIDD'S KIDS ABA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KERA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:210-326-9290
Mailing Address - Street 1:20502 PROVIDENCE POINT DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-2054
Mailing Address - Country:US
Mailing Address - Phone:210-326-9290
Mailing Address - Fax:832-301-4998
Practice Address - Street 1:20502 PROVIDENCE POINT DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-2054
Practice Address - Country:US
Practice Address - Phone:210-326-9290
Practice Address - Fax:832-301-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-17-28930OtherBCBA
TX2006OtherLBA