Provider Demographics
NPI:1407400740
Name:MAXIE, KEYARAH C (RBT)
Entity Type:Individual
Prefix:MS
First Name:KEYARAH
Middle Name:C
Last Name:MAXIE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W CENTRAL TEXAS EXPY STE 1
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-2573
Mailing Address - Country:US
Mailing Address - Phone:254-432-7041
Mailing Address - Fax:
Practice Address - Street 1:310 W CENTRAL TEXAS EXPY STE 1
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-2573
Practice Address - Country:US
Practice Address - Phone:254-432-7041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst