Provider Demographics
NPI:1568833135
Name:CURTIS, KENDALL BRIAN JR (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:BRIAN
Last Name:CURTIS
Suffix:JR
Gender:M
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 E WASHINGTON ST STE 212
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-7439
Mailing Address - Country:US
Mailing Address - Phone:602-773-5773
Mailing Address - Fax:
Practice Address - Street 1:5025 E WASHINGSTON ST #212
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034
Practice Address - Country:US
Practice Address - Phone:602-773-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
AZBEH-00061103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst