Provider Demographics
NPI:1144871583
Name:JONES, KRISTEN MARIE GILMORE (BCBA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE GILMORE
Last Name:JONES
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 1:2135 N OXNARD BLVD # 121
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2362
Mailing Address - Country:US
Mailing Address - Phone:757-633-9574
Mailing Address - Fax:
Practice Address - Street 1:16130 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3907
Practice Address - Country:US
Practice Address - Phone:818-285-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-19-36330OtherBACB