Provider Demographics
NPI:1518685981
Name:EARLEY, KAMIYAH
Entity type:Individual
Prefix:
First Name:KAMIYAH
Middle Name:
Last Name:EARLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 N DUNN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-1483
Mailing Address - Country:US
Mailing Address - Phone:260-739-8413
Mailing Address - Fax:
Practice Address - Street 1:451 S PARK RIDGE RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-8589
Practice Address - Country:US
Practice Address - Phone:812-822-0189
Practice Address - Fax:317-334-7336
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst