Provider Demographics
NPI:1770457244
Name:OATES, KENNEDY (BCBA)
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:
Last Name:OATES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4944 WATER LILY LN
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-4414
Mailing Address - Country:US
Mailing Address - Phone:972-273-0022
Mailing Address - Fax:
Practice Address - Street 1:4944 WATER LILY LN
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4414
Practice Address - Country:US
Practice Address - Phone:972-273-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst