Provider Demographics
NPI:1356848360
Name:KP BEHAVIORS OPTIONS LLC
Entity Type:Organization
Organization Name:KP BEHAVIORS OPTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ABA THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:GENELA
Authorized Official - Middle Name:GISSEL
Authorized Official - Last Name:VALLEJO DE PETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-776-4223
Mailing Address - Street 1:140 ROSCOMMON CT
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-1879
Mailing Address - Country:US
Mailing Address - Phone:470-776-4223
Mailing Address - Fax:
Practice Address - Street 1:140 ROSCOMMON CT
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-1879
Practice Address - Country:US
Practice Address - Phone:470-776-4223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-07
Last Update Date:2018-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty