Provider Demographics
NPI:1053847392
Name:SQUIRES, KYLEE (RBT)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 COLLEGE PKWY
Mailing Address - Street 2:APT. C103
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-5042
Mailing Address - Country:US
Mailing Address - Phone:775-455-5778
Mailing Address - Fax:
Practice Address - Street 1:1250 LAMOILLE HWY
Practice Address - Street 2:UNIT 310
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4396
Practice Address - Country:US
Practice Address - Phone:775-340-0712
Practice Address - Fax:775-777-1293
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician