Individual provider Active NPI

Kaitlyn Elise Terry, M.A., BCBA

  • Behavior Analyst
  • Lafayette, CA
National Provider Identifier
1912408139
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-20-43427 Issued in CA
Practice address
3650 Mt Diablo Blvd Ste 107
Lafayette, CA 94549-3768
Phone
(805) 443-7124
NPI assigned
Feb 22, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X RBT-18-47223 CA
Behavior Analyst 103K00000X 1-20-43427 CA Primary

Addresses

Primary practice location

3650 Mt Diablo Blvd Ste 107
Lafayette, CA 94549-3768

Mailing address

3650 Mt Diablo Blvd Ste 107
Lafayette, CA 94549-3768
Phone (916) 923-1789

Other practice location 1

8950 Cal Center Dr Ste 137
Sacramento, CA 95826-3236
Phone (916) 932-3172

Other practice location 2

2751 Wilmington Ave
Sacramento, CA 95820-1048
Phone (916) 923-1789

Other practice location 3

1901 Royal Oaks Dr Ste 201
Sacramento, CA 95815-4235
Phone (916) 923-1789

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
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
RBT-18-47223CAMDBehavior Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Advance Education, Inc. Behavior Analyst 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.

NPI Registry JSON

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

{
    "created_epoch": "1519257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621814400000",
    "number": "1912408139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 MT DIABLO BLVD STE 107",
            "city": "LAFAYETTE",
            "state": "CA",
            "postal_code": "945493768",
            "telephone_number": "916-923-1789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 MT DIABLO BLVD STE 107",
            "city": "LAFAYETTE",
            "state": "CA",
            "postal_code": "945493768",
            "telephone_number": "805-443-7124"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8950 Cal Center Dr Ste 137",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958263236",
            "country_code": "US",
            "telephone_number": "916-932-3172",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2751 Wilmington Ave",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958201048",
            "country_code": "US",
            "telephone_number": "916-923-1789",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1901 Royal Oaks Dr Ste 201",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958154235",
            "country_code": "US",
            "telephone_number": "916-923-1789",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TERRY",
        "first_name": "KAITLYN",
        "middle_name": "ELISE",
        "name_prefix": "Mrs.",
        "credential": "M.A., BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-22",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": "RBT-18-47223",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-20-43427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; 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.