Provider Demographics
NPI:1225662042
Name:BOEHMS, KYNDELL (MA, BCBA LBA)
Entity Type:Individual
Prefix:
First Name:KYNDELL
Middle Name:
Last Name:BOEHMS
Suffix:
Gender:F
Credentials:MA, BCBA LBA
Other - Prefix:
Other - First Name:KYNDELL
Other - Middle Name:
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS RBT
Mailing Address - Street 1:1445 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1445 E 10TH ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2017
Practice Address - Country:US
Practice Address - Phone:615-962-5271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
TN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst