Provider Demographics
NPI:1093228462
Name:WHITE, KYLE (BCABA)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 N TUSTIN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-7875
Mailing Address - Country:US
Mailing Address - Phone:855-581-0100
Mailing Address - Fax:855-329-3973
Practice Address - Street 1:2615 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2225
Practice Address - Country:US
Practice Address - Phone:833-223-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-17-7943106E00000X
CA1-17-28217103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst