Provider Demographics
NPI:1336781665
Name:HOMLER, KAITLIN ADELL (MA, BCABA)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ADELL
Last Name:HOMLER
Suffix:
Gender:F
Credentials:MA, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 OLD HIGHWAY 51 S STE F
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:TN
Mailing Address - Zip Code:38011-8025
Mailing Address - Country:US
Mailing Address - Phone:901-290-3916
Mailing Address - Fax:205-278-5869
Practice Address - Street 1:1880 OLD HIGHWAY 51 S STE F
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:TN
Practice Address - Zip Code:38011-8025
Practice Address - Country:US
Practice Address - Phone:901-290-3916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0-24-15410106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst