Provider Demographics
NPI:1437758232
Name:SOULEOTES, KARISSA MARGARET (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:MARGARET
Last Name:SOULEOTES
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9943 FOREST GREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5123
Mailing Address - Country:US
Mailing Address - Phone:502-830-9454
Mailing Address - Fax:
Practice Address - Street 1:9943 FOREST GREEN BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-5123
Practice Address - Country:US
Practice Address - Phone:502-830-9454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRBT-20-136912106S00000X
KY1-23-68521103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician