Provider Demographics
NPI:1164876728
Name:KILLE, IRCIA MEREDITH (BCBA)
Entity Type:Individual
Prefix:MS
First Name:IRCIA
Middle Name:MEREDITH
Last Name:KILLE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:IRCIA
Other - Middle Name:MEREDITH
Other - Last Name:ALONZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA, BCABA
Mailing Address - Street 1:7475 SOUVERAIN LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-5656
Mailing Address - Country:US
Mailing Address - Phone:775-343-2065
Mailing Address - Fax:
Practice Address - Street 1:150 E MAIN ST STE 430
Practice Address - Street 2:
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408-7744
Practice Address - Country:US
Practice Address - Phone:775-343-2065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-16-19673103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVLBA0519OtherNEVADA LICENSED BEHAVIOR ANALYST
NVBCBA1-21-47775OtherBOARD CERTIFIED BEHAVIOR ANALYST
NVRBT-16-19673OtherBACB