Provider Demographics
NPI:1164920906
Name:SMITH, CARLEY ROSE (MA, BCBA)
Entity Type:Individual
Prefix:MS
First Name:CARLEY
Middle Name:ROSE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 SILVERHEEL ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-5316
Mailing Address - Country:US
Mailing Address - Phone:913-745-8910
Mailing Address - Fax:913-273-2452
Practice Address - Street 1:6910 SILVERHEEL ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-5316
Practice Address - Country:US
Practice Address - Phone:913-405-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst