Provider Demographics
NPI:1164300786
Name:GARY, KAITLYN ELIZABETH (RBT)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ELIZABETH
Last Name:GARY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:ELIZABETH
Other - Last Name:SMILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1806 SAGEBRUSH DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-1441
Mailing Address - Country:US
Mailing Address - Phone:315-975-7014
Mailing Address - Fax:
Practice Address - Street 1:2300 CLEAR CREEK RD STE 301
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-5874
Practice Address - Country:US
Practice Address - Phone:254-768-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician