Provider Demographics
NPI:1003373127
Name:KHAMIS, KHALED (BCBA)
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:
Last Name:KHAMIS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24253 ALYDAR LOOP
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-0330
Mailing Address - Country:US
Mailing Address - Phone:251-235-2531
Mailing Address - Fax:833-997-2206
Practice Address - Street 1:101 VILLA DR STE 270
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4671
Practice Address - Country:US
Practice Address - Phone:251-235-2531
Practice Address - Fax:833-997-2206
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 106E00000X
AL2021-064103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst