Provider Demographics
NPI:1841772837
Name:PATRY, MARY (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:PATRY
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12315 CHEROKEE LN
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1437
Mailing Address - Country:US
Mailing Address - Phone:303-249-4585
Mailing Address - Fax:
Practice Address - Street 1:12315 CHEROKEE LN
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-1437
Practice Address - Country:US
Practice Address - Phone:303-249-4585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS115103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst