Provider Demographics
NPI:1689191447
Name:TAYLOR, KYLE ARON (QASP-S)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ARON
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:QASP-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E MIRACLE STRIP PKWY STE 503
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1991
Mailing Address - Country:US
Mailing Address - Phone:850-374-3991
Mailing Address - Fax:855-445-0214
Practice Address - Street 1:124 E MIRACLE STRIP PKWY STE 503
Practice Address - Street 2:
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1991
Practice Address - Country:US
Practice Address - Phone:850-301-0438
Practice Address - Fax:850-862-6270
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-28666106S00000X
FL13219106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician