Provider Demographics
NPI:1194448530
Name:MALONE, KENEISHA (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KENEISHA
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6840 SKYLAR MILL AVE
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8793
Mailing Address - Country:US
Mailing Address - Phone:314-443-4831
Mailing Address - Fax:
Practice Address - Street 1:6840 SKYLAR MILL AVE
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8793
Practice Address - Country:US
Practice Address - Phone:314-443-4831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1046103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst