Provider Demographics
NPI:1699095489
Name:BIVENS, KELLY LYNNE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LYNNE
Last Name:BIVENS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:LYNNE
Other - Last Name:KAINER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:18401 TIMBER FOREST DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2535
Mailing Address - Country:US
Mailing Address - Phone:281-852-0501
Mailing Address - Fax:
Practice Address - Street 1:1009 PRUITT RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-3024
Practice Address - Country:US
Practice Address - Phone:281-610-1987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1151103K00000X
TX1-05-2141103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst