Provider Demographics
NPI:1114417748
Name:WHITLOCK, KIANA JADE (MA, BCBA, LBA)
Entity Type:Individual
Prefix:MS
First Name:KIANA
Middle Name:JADE
Last Name:WHITLOCK
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 WORTH PKWY APT 2426
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1516
Mailing Address - Country:US
Mailing Address - Phone:210-935-2707
Mailing Address - Fax:
Practice Address - Street 1:24870 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-6674
Practice Address - Country:US
Practice Address - Phone:210-756-8586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5579103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst