Provider Demographics
NPI:1316404692
Name:COVINGTON, KELLEEN EVE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:KELLEEN
Middle Name:EVE
Last Name:COVINGTON
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 1:1961 NORTHPOINT BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4999
Mailing Address - Country:US
Mailing Address - Phone:423-498-9051
Mailing Address - Fax:
Practice Address - Street 1:1961 NORTHPOINT BLVD STE 140
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4999
Practice Address - Country:US
Practice Address - Phone:423-498-9051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABACB507414103K00000X, 106E00000X
106S00000X
TN103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician