Provider Demographics
NPI:1164265641
Name:GREGORY, KORI LYNN (RBT)
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:LYNN
Last Name:GREGORY
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 1:500 E HIGHMEADOW DR APT 2205
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1332
Mailing Address - Country:US
Mailing Address - Phone:619-213-8156
Mailing Address - Fax:
Practice Address - Street 1:500 E HIGHMEADOW DR APT 2205
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-1332
Practice Address - Country:US
Practice Address - Phone:619-213-8156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-23-311006106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician