Provider Demographics
NPI:1871159210
Name:JOHNSON, KAYLA (RBT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 DUBLIN CT
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8035
Mailing Address - Country:US
Mailing Address - Phone:501-286-9941
Mailing Address - Fax:
Practice Address - Street 1:2510 LAKELAND TER
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4702
Practice Address - Country:US
Practice Address - Phone:782-760-1982
Practice Address - Fax:601-982-0800
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician