Provider Demographics
NPI:1316524283
Name:REVELL, CAITLIN (MS, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:REVELL
Suffix:
Gender:
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 PALATKA RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-3419
Mailing Address - Country:US
Mailing Address - Phone:502-240-7128
Mailing Address - Fax:
Practice Address - Street 1:9900 SHELBYVILLE RD STE 8
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2965
Practice Address - Country:US
Practice Address - Phone:502-915-8796
Practice Address - Fax:502-805-0765
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY298005103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst