Provider Demographics
NPI:1104271501
Name:FAIRCLOUGH, KAHIYA (BCBA)
Entity type:Individual
Prefix:
First Name:KAHIYA
Middle Name:
Last Name:FAIRCLOUGH
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 1:5575 S SEMORAN BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-1781
Mailing Address - Country:US
Mailing Address - Phone:844-331-6451
Mailing Address - Fax:
Practice Address - Street 1:2218 MAHAN DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-6127
Practice Address - Country:US
Practice Address - Phone:850-320-6555
Practice Address - Fax:888-873-4610
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019974800Medicaid