Provider Demographics
NPI:1730698432
Name:SMITH, KAITLYN LEE (MS, BCBA, LBA)
Entity type:Individual
Prefix:MS
First Name:KAITLYN
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:MS
Other - First Name:KAITLYN
Other - Middle Name:LEE
Other - Last Name:STAFFIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1702 N COLLINS BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3655
Mailing Address - Country:US
Mailing Address - Phone:972-746-9012
Mailing Address - Fax:
Practice Address - Street 1:1702 N COLLINS BLVD STE 250
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3655
Practice Address - Country:US
Practice Address - Phone:972-746-9012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1142103K00000X
TX1-17-27410103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst