Active NPI
Kennedy Collins
- Behavior Technician
- Southlake, TX
National Provider Identifier
1376244533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 22-203498
- Practice address
- 2104 Greenbriar Dr
Southlake, TX 76092-8355 - Phone
- (817) 442-9022
- NPI assigned
- Mar 14, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 22-203498 | FL | Primary |
Addresses
Primary practice location
2104 Greenbriar Dr
Southlake, TX 76092-8355
Mailing address
18449 Oakwood Ave
Lansing, IL 60438-2907
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22-203498 | FL | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pine Cone Therapies LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Behavior Analyst
- Southlake, TX
- NPI 1013143767
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678752000000",
"number": "1376244533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18449 OAKWOOD AVE",
"city": "LANSING",
"state": "IL",
"postal_code": "604382907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2104 GREENBRIAR DR",
"city": "SOUTHLAKE",
"state": "TX",
"postal_code": "760928355",
"telephone_number": "817-442-9022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLINS",
"first_name": "KENNEDY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-03-14",
"last_updated": "2023-03-14",
"certification_date": "2023-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "22-203498",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southlake, TX
- Colleyville MD Associates
- Grace Collier
- Dwayne Collins, MA, LPC
- Dwayne L. Collins, RN, MSN, FNP-C
- Jill Collins, DPT
- Compass Christian Counseling Ministries (Compass Counseling)
- Compassion Dermatology, PLLC
- Compassion Neuroscience
- Compassionate Psychiatric Services of Southlake PA (Compassionate Psychiatric Services of Southlake)
- Complete Emergency Care Southlake LLC (Complete Care Southlake)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.