Provider Demographics
NPI:1518210160
Name:TUCKER, KAYLEIGH (BCBA)
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KAYLEIGH
Other - Middle Name:
Other - Last Name:MATTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4221 WILSHIRE BLVD STE 300A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3537
Mailing Address - Country:US
Mailing Address - Phone:888-428-3223
Mailing Address - Fax:323-866-1881
Practice Address - Street 1:7200 S ALTON WAY STE A100
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2207
Practice Address - Country:US
Practice Address - Phone:904-508-4034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11519851103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst