Provider Demographics
NPI:1952887697
Name:KYLES, MIRANDA (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:MIRANDA
Middle Name:
Last Name:KYLES
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 1:555 NE 8TH ST APT 1201
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2994
Mailing Address - Country:US
Mailing Address - Phone:321-848-4924
Mailing Address - Fax:
Practice Address - Street 1:555 NE 8TH ST APT 1201
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-2994
Practice Address - Country:US
Practice Address - Phone:321-848-4924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
FL12147693103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician