Provider Demographics
NPI:1154627966
Name:QUINN, KYLE (BCBA)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:QUINN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:KYLE
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:8 THE GREEN
Mailing Address - Street 2:STE R
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3618
Mailing Address - Country:US
Mailing Address - Phone:239-354-7273
Mailing Address - Fax:239-354-7273
Practice Address - Street 1:1834 FIELDS BLVD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-3029
Practice Address - Country:US
Practice Address - Phone:317-527-5437
Practice Address - Fax:317-318-1356
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
01096676103K00000X
OH00435103K00000X
TX3154103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300012092Medicaid