Provider Demographics
NPI:1225866833
Name:HARKENRIDER, KASY CELESE (BCBA)
Entity type:Individual
Prefix:
First Name:KASY
Middle Name:CELESE
Last Name:HARKENRIDER
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 1:2580 CHIMNEY HILL PL
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1766
Mailing Address - Country:US
Mailing Address - Phone:678-629-1338
Mailing Address - Fax:
Practice Address - Street 1:3832 SW 33RD CT
Practice Address - Street 2:
Practice Address - City:WEST PARK
Practice Address - State:FL
Practice Address - Zip Code:33023-5631
Practice Address - Country:US
Practice Address - Phone:954-947-5061
Practice Address - Fax:954-838-5358
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12471643103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst