Provider Demographics
NPI:1770388720
Name:PHIFER, KIRASTEN RAYE (RBT)
Entity type:Individual
Prefix:MS
First Name:KIRASTEN
Middle Name:RAYE
Last Name:PHIFER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:KIRASTEN
Other - Middle Name:RAYE
Other - Last Name:PHIFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KIRASTEN PHIFER, RBT
Mailing Address - Street 1:4075 PARK AVENUE MEMPHIS TN 38152
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38152-0001
Mailing Address - Country:US
Mailing Address - Phone:901-584-8281
Mailing Address - Fax:
Practice Address - Street 1:4075 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-7400
Practice Address - Country:US
Practice Address - Phone:901-692-7930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-25-410921106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician