Provider Demographics
NPI:1821504218
Name:KING, BREANNA CAMILLE (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:CAMILLE
Last Name:KING
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16974 E WYOMING DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-5291
Mailing Address - Country:US
Mailing Address - Phone:808-368-4412
Mailing Address - Fax:
Practice Address - Street 1:6065 S QUEBEC ST STE 100
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4575
Practice Address - Country:US
Practice Address - Phone:720-259-5479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician