Provider Demographics
NPI:1003310962
Name:GREER, KAITLYN MOURO (BCBA)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MOURO
Last Name:GREER
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 1:3401 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6934
Mailing Address - Country:US
Mailing Address - Phone:803-216-1089
Mailing Address - Fax:803-339-1907
Practice Address - Street 1:3401 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6934
Practice Address - Country:US
Practice Address - Phone:817-874-5812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-20-43864103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst