Provider Demographics
NPI:1154084960
Name:MICHAEL, KAYLEE CORRINE (MA, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:KAYLEE
Middle Name:CORRINE
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:MS
Other - First Name:KAYLEE
Other - Middle Name:CORRINE
Other - Last Name:PICKWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17302 HOUSE & HAHL RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12101 GRANT RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-2761
Practice Address - Country:US
Practice Address - Phone:281-223-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4478103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst