Provider Demographics
NPI:1144572306
Name:FREI, KYLEA SUE (EDD, BCBA, QMHS)
Entity type:Individual
Prefix:DR
First Name:KYLEA
Middle Name:SUE
Last Name:FREI
Suffix:
Gender:F
Credentials:EDD, BCBA, QMHS
Other - Prefix:
Other - First Name:KYLEA
Other - Middle Name:SUE
Other - Last Name:CORBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QMHS
Mailing Address - Street 1:201 MONTERAY AVE
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45419-2650
Mailing Address - Country:US
Mailing Address - Phone:937-477-6884
Mailing Address - Fax:
Practice Address - Street 1:4134 LINDEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3000
Practice Address - Country:US
Practice Address - Phone:937-365-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 251S00000X
OH1-11-8570103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0294053Medicaid
OH0003068Medicaid