Provider Demographics
NPI:1528377512
Name:NEWSOME, KENDRA BROOKS (PHD, BCBA-D)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:BROOKS
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:BROOKS
Other - Last Name:RICKARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, BCBA-D
Mailing Address - Street 1:9408 DOUBLE R. SUITE B
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521
Mailing Address - Country:US
Mailing Address - Phone:775-826-3111
Mailing Address - Fax:775-826-3110
Practice Address - Street 1:9408 DOUBLE R. SUITE B
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521
Practice Address - Country:US
Practice Address - Phone:775-826-3111
Practice Address - Fax:775-826-3110
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLBAT041611103K00000X
1-09-5738103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst