Provider Demographics
NPI:1891147252
Name:KINGREY, MALLORY DANIELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:DANIELLE
Last Name:KINGREY
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 1:9766 N KITCHEN RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-6537
Mailing Address - Country:US
Mailing Address - Phone:317-888-1557
Mailing Address - Fax:
Practice Address - Street 1:360 POLK ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1623
Practice Address - Country:US
Practice Address - Phone:317-888-1557
Practice Address - Fax:317-888-1571
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst