Kevin Douglas, MA, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-16-21667 Issued in CA

Practice address

3473 Cannon Way
Live Oak, CA 95953-9654

Phone

(630) 635-1091

NPI assigned

Apr 5, 2016

Last updated

Apr 18, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• S William Ablel Academy

  • Local Education Agency (LEA)
  • Williams, CA
  • NPI 1871486738
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460937600000",
    "number": "1679936785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3473 CANNON WAY",
            "city": "LIVE OAK",
            "state": "CA",
            "postal_code": "959539654",
            "telephone_number": "630-635-1091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3473 CANNON WAY",
            "city": "LIVE OAK",
            "state": "CA",
            "postal_code": "959539654",
            "telephone_number": "630-635-1091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "KEVIN",
        "credential": "MA, BCBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-05",
        "last_updated": "2016-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-16-21667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caleb Andrew Collier, DPT
• Yesenia Corona
• Juan De la Torre
• Dhugga Investments LLC (Live Oak Pharmacy)
• Marisol Diaz
• Feather River Men's Center
• Flax Holdings, LLC (River Valley Care Center)
• Nichole Furr
• Alicia Maria Garcia
• Charles Arbie Garretson, MD

• Behavior Analyst in Live Oak, CA
• Providers in Live Oak, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.