Provider Demographics
NPI:1275395287
Name:PRIEST, KEVIN JAMES (BCBA, LBS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:PRIEST
Suffix:
Gender:M
Credentials:BCBA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 S DARIEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-5136
Mailing Address - Country:US
Mailing Address - Phone:916-206-1391
Mailing Address - Fax:
Practice Address - Street 1:2801 GRANT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1032
Practice Address - Country:US
Practice Address - Phone:215-878-3400
Practice Address - Fax:267-531-0005
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH006568103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst