Provider Demographics
NPI:1063141257
Name:MINTON, KAYLEE MARIE (RBT)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:MARIE
Last Name:MINTON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:MARIE
Other - Last Name:MARTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:1824 TOUBY PIKE STE B
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-2573
Mailing Address - Country:US
Mailing Address - Phone:765-628-7400
Mailing Address - Fax:765-865-8549
Practice Address - Street 1:209 CHRISTIE DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-5549
Practice Address - Country:US
Practice Address - Phone:936-404-3679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-21-174166106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty