Provider Demographics
NPI:1255948832
Name:PITZER, KAYLA MAREE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MAREE
Last Name:PITZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:MAREE
Other - Last Name:FINEOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5076 CREEKSIDE TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-3898
Mailing Address - Country:US
Mailing Address - Phone:762-359-0003
Mailing Address - Fax:844-308-5830
Practice Address - Street 1:1639 BRADLEY PARK DR STE 500
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3623
Practice Address - Country:US
Practice Address - Phone:762-359-0003
Practice Address - Fax:844-308-5830
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 106E00000X
RBT-20-124971106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician