Provider Demographics
NPI:1457196008
Name:BLAKLEY, KAYTLIN DANIELLE (BCBA)
Entity type:Individual
Prefix:
First Name:KAYTLIN
Middle Name:DANIELLE
Last Name:BLAKLEY
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 1:270 BEECHCREEK WOOD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-5502
Mailing Address - Country:US
Mailing Address - Phone:936-252-6513
Mailing Address - Fax:
Practice Address - Street 1:304 W MILL ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-3227
Practice Address - Country:US
Practice Address - Phone:936-441-2200
Practice Address - Fax:936-570-9088
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7127103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst