Provider Demographics
NPI:1922859107
Name:KALEIDOVERSE ABA LLC
Entity Type:Organization
Organization Name:KALEIDOVERSE ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:936-242-2926
Mailing Address - Street 1:309 LOCHVALE PEAK CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-2183
Mailing Address - Country:US
Mailing Address - Phone:936-242-2926
Mailing Address - Fax:
Practice Address - Street 1:309 LOCHVALE PEAK CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-2183
Practice Address - Country:US
Practice Address - Phone:936-242-2926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health