Provider Demographics
NPI:1376196543
Name:KIERAN, MICHAEL (MS BCBA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KIERAN
Suffix:
Gender:M
Credentials:MS BCBA
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:M
Other - Last Name:KIERAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:55 DECLARATION DR STE B
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4965
Mailing Address - Country:US
Mailing Address - Phone:530-487-7265
Mailing Address - Fax:530-487-7263
Practice Address - Street 1:55 DECLARATION DR STE B
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4965
Practice Address - Country:US
Practice Address - Phone:530-487-7265
Practice Address - Fax:530-487-7263
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-36407103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst