Provider Demographics
NPI:1275996282
Name:MEYER, KACIE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 399318
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-9318
Mailing Address - Country:US
Mailing Address - Phone:665-234-2688
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:1215 HIGHTOWER TRL STE B120
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-6205
Practice Address - Country:US
Practice Address - Phone:602-497-6124
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-16-21466103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst