Provider Demographics
NPI:1689181141
Name:KENDALL, KYRA-DENISE (RBT)
Entity Type:Individual
Prefix:
First Name:KYRA-DENISE
Middle Name:
Last Name:KENDALL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553A MIKIOI PL
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-9458
Mailing Address - Country:US
Mailing Address - Phone:541-708-1768
Mailing Address - Fax:
Practice Address - Street 1:1847 S KIHEI RD
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7939
Practice Address - Country:US
Practice Address - Phone:808-879-4111
Practice Address - Fax:808-879-4118
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-16-21309106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician