Provider Demographics
NPI:1083176002
Name:GERVAIS, KATELYNN MIKAEL (RBT)
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:MIKAEL
Last Name:GERVAIS
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 1:915 BLANCO CIR STE C
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4450
Mailing Address - Country:US
Mailing Address - Phone:831-262-5269
Mailing Address - Fax:831-998-7682
Practice Address - Street 1:915 BLANCO CIR STE C
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4450
Practice Address - Country:US
Practice Address - Phone:831-262-5269
Practice Address - Fax:831-998-7682
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-18-71942106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician