Provider Demographics
NPI:1871847921
Name:GREEN, KIMMERLE T (BCBA)
Entity Type:Individual
Prefix:MS
First Name:KIMMERLE
Middle Name:T
Last Name:GREEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 STRADER DR STE 150
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-4090
Mailing Address - Country:US
Mailing Address - Phone:859-899-9200
Mailing Address - Fax:859-899-9202
Practice Address - Street 1:1035 STRADER DR STE 150
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4090
Practice Address - Country:US
Practice Address - Phone:859-899-9200
Practice Address - Fax:859-899-9202
Is Sole Proprietor?:No
Enumeration Date:2012-10-28
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst