Provider Demographics
NPI:1164189767
Name:YEARWOOD, KAYLA LOUISE (RBT-21-183066)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:LOUISE
Last Name:YEARWOOD
Suffix:
Gender:F
Credentials:RBT-21-183066
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 WEATHERSTONE DR STE 530
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-7006
Mailing Address - Country:US
Mailing Address - Phone:770-591-9552
Mailing Address - Fax:800-218-8249
Practice Address - Street 1:107 WEATHERSTONE DR STE 530
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-7006
Practice Address - Country:US
Practice Address - Phone:770-591-9552
Practice Address - Fax:800-218-8249
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-183066106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-21-183066OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD