Provider Demographics
NPI:1508629882
Name:FOREMAN, KYEISHA (BCBA, LBA)
Entity Type:Individual
Prefix:MS
First Name:KYEISHA
Middle Name:
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 CORRIGAN HTS RD
Mailing Address - Street 2:
Mailing Address - City:CORRIGAN
Mailing Address - State:TX
Mailing Address - Zip Code:75939-8083
Mailing Address - Country:US
Mailing Address - Phone:936-635-1714
Mailing Address - Fax:
Practice Address - Street 1:6844 N US HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:POLLOK
Practice Address - State:TX
Practice Address - Zip Code:75969-4548
Practice Address - Country:US
Practice Address - Phone:936-634-3353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5863103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty