Provider Demographics
NPI:1104553544
Name:BAHRAMI, KATHRYN (MAT, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BAHRAMI
Suffix:
Gender:F
Credentials:MAT, BCBA, LBA
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAT, BCBA
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:9930 KINCEY AVE STE 140
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6541
Practice Address - Country:US
Practice Address - Phone:980-380-9775
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-22-62304103K00000X
1-22-62304103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty