Provider Demographics
NPI:1649665100
Name:TAILLON, ABREE A (BCBA, PLMHP)
Entity type:Individual
Prefix:
First Name:ABREE
Middle Name:A
Last Name:TAILLON
Suffix:
Gender:F
Credentials:BCBA, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-0492
Mailing Address - Country:US
Mailing Address - Phone:308-224-7652
Mailing Address - Fax:
Practice Address - Street 1:1708 E 46TH STREET PL
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2696
Practice Address - Country:US
Practice Address - Phone:308-455-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2015-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NE10530101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-15-18579OtherBEHAVIOR ANALYST CERTIFICATION BOARD