Provider Demographics
NPI:1154979490
Name:DECKER, KENDALL (BCBA)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:DECKER
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 1:10338 E 11TH ST # 105
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74128-3008
Mailing Address - Country:US
Mailing Address - Phone:918-978-3861
Mailing Address - Fax:
Practice Address - Street 1:10338 E 11TH ST # 105
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74128-3008
Practice Address - Country:US
Practice Address - Phone:189-978-3861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3025103K00000X
TX106S00000X
OK1-19-38478103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician