Provider Demographics
NPI:1053678623
Name:PIPER, KIMBERLY (BCBA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PIPER
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 1:307 E PARK AVE # 301
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-2320
Mailing Address - Country:US
Mailing Address - Phone:406-880-0673
Mailing Address - Fax:406-643-2023
Practice Address - Street 1:307 E PARK AVE # 301
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2320
Practice Address - Country:US
Practice Address - Phone:406-880-0673
Practice Address - Fax:406-643-2023
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MTPSY-BA-LIC2489103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst