Provider Demographics
NPI:1003567694
Name:JOHNSON, KAYT-LYN
Entity Type:Individual
Prefix:
First Name:KAYT-LYN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4598
Mailing Address - Country:US
Mailing Address - Phone:512-588-1362
Mailing Address - Fax:512-279-2483
Practice Address - Street 1:2105 E PARK ST
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4598
Practice Address - Country:US
Practice Address - Phone:512-588-1362
Practice Address - Fax:512-279-2483
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst