Provider Demographics
NPI:1396247243
Name:KEVERN, CARLA ANN (BCBA, DTLLP, NCSP)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:ANN
Last Name:KEVERN
Suffix:
Gender:F
Credentials:BCBA, DTLLP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2481 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-1247
Mailing Address - Country:US
Mailing Address - Phone:231-215-3877
Mailing Address - Fax:
Practice Address - Street 1:316 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49440-1148
Practice Address - Country:US
Practice Address - Phone:231-215-3877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6352000605103T00000X
MI103TS0200X
MIRBT-17-43316106S00000X
MI1-20-41448103K00000X
MI6362008893103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty