Provider Demographics
NPI:1649506189
Name:BYRA, KRISTEN LYNN (PHD, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:LYNN
Last Name:BYRA
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15217 S CAMINO GLORIETA ALEGRE
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-8463
Mailing Address - Country:US
Mailing Address - Phone:860-671-1367
Mailing Address - Fax:
Practice Address - Street 1:3323 N CAMPBELL AVE STE 1
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2360
Practice Address - Country:US
Practice Address - Phone:860-671-1367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-18
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-07-3523103K00000X
AZBA-54103K00000X
NVLBAT081211103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst