Provider Demographics
NPI:1780318915
Name:PICKARTZ, KAYLEE LAUREN (BCBA)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:LAUREN
Last Name:PICKARTZ
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:PO BOX 10921
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-0921
Mailing Address - Country:US
Mailing Address - Phone:479-206-2057
Mailing Address - Fax:479-401-2595
Practice Address - Street 1:5604 ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3224
Practice Address - Country:US
Practice Address - Phone:479-926-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst