Provider Demographics
NPI:1770135139
Name:ANDERSON, KYRA MARGARET (BCBA)
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:MARGARET
Last Name:ANDERSON
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 1:2795 N SPEER BLVD APT 315
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4283
Mailing Address - Country:US
Mailing Address - Phone:612-518-3121
Mailing Address - Fax:
Practice Address - Street 1:6750 W 52ND AVE STE G
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-3928
Practice Address - Country:US
Practice Address - Phone:720-706-3396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MN103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst