Provider Demographics
NPI:1326694720
Name:CHAVEZ, KAYLA M (RBT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:M
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:M
Other - Last Name:BEARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:291 CLEAR SKY CT STE C
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5951
Mailing Address - Country:US
Mailing Address - Phone:404-580-0694
Mailing Address - Fax:
Practice Address - Street 1:291 CLEAR SKY CT STE C
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5951
Practice Address - Country:US
Practice Address - Phone:404-580-0694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-193072106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-19-91757OtherBEHAVIOR ANALYST CERTIFICATION BOARD (BACB)