Provider Demographics
NPI:1609221746
Name:WEBB, KRISTIN RHEA (BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:RHEA
Last Name:WEBB
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:RHEA
Other - Last Name:MCKEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4061 SUZANNE DR STE C&D
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-3735
Mailing Address - Country:US
Mailing Address - Phone:228-396-4434
Mailing Address - Fax:228-396-4438
Practice Address - Street 1:4061 SUZANNE DR STE CANDD
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-3735
Practice Address - Country:US
Practice Address - Phone:228-396-4434
Practice Address - Fax:228-396-4438
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS200054103K00000X
MSRBT# 16-12451103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1891084414OtherMS CENTERS FOR AUTISM AND OTHER RELATED DEVELOPMENTAL DISABILITIES