Provider Demographics
NPI:1982372603
Name:LONG, KAYLA BROOKE (BCBA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:BROOKE
Last Name:LONG
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 1:7492 PRESSLER GRV APT C
Mailing Address - Street 2:
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121-2255
Mailing Address - Country:US
Mailing Address - Phone:270-734-5957
Mailing Address - Fax:
Practice Address - Street 1:390 GIVENS LN
Practice Address - Street 2:
Practice Address - City:EASTVIEW
Practice Address - State:KY
Practice Address - Zip Code:42732-9714
Practice Address - Country:US
Practice Address - Phone:270-734-5957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY285465103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst