Provider Demographics
NPI:1609057488
Name:SCHAMA, KEVIN (PH D, BCBA-D)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:SCHAMA
Suffix:
Gender:M
Credentials:PH D, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5788
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-5788
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:423-434-2979
Practice Address - Street 1:108 N BELLEVUE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-1512
Practice Address - Country:US
Practice Address - Phone:573-987-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019015119103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst