Provider Demographics
NPI:1114528916
Name:STIPE, KAYLEE SHAY (MA, BCBA)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:SHAY
Last Name:STIPE
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6075 NAILS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-2680
Mailing Address - Country:US
Mailing Address - Phone:912-278-1064
Mailing Address - Fax:
Practice Address - Street 1:6075 NAILS FERRY RD
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-2680
Practice Address - Country:US
Practice Address - Phone:912-278-1064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-24-74067103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst