Provider Demographics
NPI:1740828409
Name:CAIN, KASSANDRA LYNN (MA, BCBA)
Entity type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:LYNN
Last Name:CAIN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 NW GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-6000
Mailing Address - Country:US
Mailing Address - Phone:405-594-8336
Mailing Address - Fax:832-383-5347
Practice Address - Street 1:16538 N MAY AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-9007
Practice Address - Country:US
Practice Address - Phone:405-265-9208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-21-50405103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst