Provider Demographics
NPI:1154994226
Name:SANFORD, KAYLEE CORRINE (RBT)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:CORRINE
Last Name:SANFORD
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 W TOWN CENTER CIR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3734
Mailing Address - Country:US
Mailing Address - Phone:281-570-2420
Mailing Address - Fax:
Practice Address - Street 1:2825 W TOWN CENTER CIR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3734
Practice Address - Country:US
Practice Address - Phone:281-570-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-160219106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician