KRISTYN ALYSE PEACOCK (NPI# 1639787153) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639787153 |
| Entity Type | Individual |
| Full Name | KRISTYN ALYSE PEACOCK |
| Practice Address |
2522 E 70th St Shreveport LA 71105-4002 |
| Practice Telephone | 3187953388 |
| Mailing Telephone | 3187953388 |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2020-07-21 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106S00000X | Behavior Technician | R-6833 | LA | Behavioral Health & Social Service Providers |
| Street Address |
2522 E 70TH ST |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71105-4002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891015855 | Lacey J Mcbride | Speech-Language Pathologist | 2522 E 70th St, Shreveport, LA 71105-4002 | 2010-06-01 |
| 1013524875 | Elizabeth Mae Fargerson | Assistant Behavior Analyst | 2522 E 70th St, Shreveport, LA 71105-4002 | 2020-09-25 |
| 1033727565 | Olivia Felsher-smith | Behavior Technician | 2522 E 70th St, Shreveport, LA 71105-4002 | 2020-07-21 |
| 1760090245 | Doughty Mccall Cowart | Behavior Technician | 2522 E 70th St, Shreveport, LA 71105-4002 | 2020-07-21 |
| 1003430471 | Ashley King | Behavioral Analyst | 2522 E 70th St, Shreveport, LA 71105-4002 | 2020-06-02 |
| 1922635416 | Erika Loren Tejada | Speech-Language Pathologist | 2522 E 70th St, Shreveport, LA 71105-4002 | 2020-03-24 |
| 1760018477 | Mary Katherine Walker | Speech-Language Pathologist | 2522 E 70th St, Shreveport, LA 71105-4002 | 2020-03-14 |
| 1801434428 | Savanna Taelor Witthoeft | Behavior Technician | 2522 E 70th St, Shreveport, LA 71105-4002 | 2019-12-13 |
| 1164068615 | Megan Theriot | Behavior Technician | 2522 E 70th St, Shreveport, LA 71105-4002 | 2019-11-20 |
| 1114562253 | Amber S Wynn | Behavior Technician | 2522 E 70th St, Shreveport, LA 71105-4002 | 2019-11-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699245928 | Misty Johnetta Ross | Counselor | 2942 Knight St., Bldg. 4 Suite 426, Shreveport, LA 71105 | 2018-11-29 |
| 1205301868 | Tatjhana Maury | Case Manager/Care Coordinator | 3325 Youree Drive, Shreveport, LA 71105 | 2018-10-10 |
| 1245710920 | Jefferey Douglas Adair Md | Non-Pharmacy Dispensing Site | 8860 Fern Ave., Suite 120, Shreveport, LA 71105 | 2018-08-21 |
| 1679059539 | Michael E Woolbert Dds LLC | Dentist | 7600 Fern Avenue, Building 1100, Shreveport, LA 71105 | 2018-07-13 |
| 1881195675 | Adiba Bibi | Pharmacist | 3555 Greenwood Road, Walgreens, Shreveport, LA 71105 | 2018-02-27 |
| 1740796655 | Allison Borel | Counselor | 2020 E 70th St Ste 201, Shreveport, LA 71105 | 2017-12-15 |
| 1073028148 | Valerie Wooten Barcelona | Physical Therapist | 130 Kayla Street, Shreveport, LA 71105 | 2017-12-11 |
| 1710497615 | Jimmy Carroll | Counselor | 2960 Knight St, Suite 110, Shreveport, LA 71105 | 2017-10-05 |
| 1932618444 | David Louis Bennett | Counselor | 3007 Knight St., Suite 200, Shreveport, LA 71105 | 2017-09-27 |
| 1619496452 | Shaqwana Hodge | Counselor | 2920 Knight St. Suite 110, Shreveport, LA 71105 | 2017-09-13 |
| Find all providers in zip 71105 | ||||
| Taxonomy Code | 106S00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Behavior Technician |
| The behavior technician is a paraprofessional who practices under the close, ongoing supervision of a behavior analyst or assistant behavior analyst certified by the Behavior Analyst Certification Board and/or credentialed by a state (such as through licensure). The behavior technician is primarily responsible for the implementation of components of behavior-analytic treatment plans developed by the supervisor. That may include collecting data on treatment targets and conducting certain types of behavioral assessments (e.g., stimulus preference assessments). The behavior technician does not design treatment or assessment plans or procedures but provides services as assigned by the supervisor responsible for his or her work. |
| Notes: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2016: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417597782 | Camille Brooke Williams | Behavior Technician | 7607 Fern Avw, 403, Shreveport, LA 71105-5699 | 2020-01-14 |
| 1881163509 | Lavonda Moore | Behavior Technician | 7607 Fern Ave Ste 404405, Shreveport, LA 71105-5739 | 2018-11-26 |
| 1316467798 | Charles L Tilley Jr. | Behavior Technician | 4642 Bethume Dr, Shreveport, LA 71109-6634 | 2017-06-26 |
| 1346760717 | Melvina Harris | Behavior Technician | 700 Pierre Ave Ste A, Shreveport, LA 71103-2725 | 2017-06-26 |
| 1427588045 | Mark Rogers | Behavior Technician | 1500 N. Market Unit C Suite 105, Shreveport, LA 71107 | 2017-06-15 |
| 1396273249 | Kanisha Michelle Cooper | Behavior Technician | 1500 N Market St Ste C104, Shreveport, LA 71107-6545 | 2017-05-23 |
| 1740723345 | Patrice Bennett | Behavior Technician | 3817 Woodrow Ave, Shreveport, LA 71109-4435 | 2016-11-30 |
| 1013450154 | Vonetta Cook | Behavior Technician | 2715 Mackey Pl # Pl135, Shreveport, LA 71118-2544 | 2016-11-21 |
| 1386186625 | Barbara Simpson | Behavior Technician | 4130 Clover St, Shreveport, LA 71109-7220 | 2016-11-16 |
| 1548702749 | Evangela Robertson | Behavior Technician | 1651 E 70th St # 259, Shreveport, LA 71105-5115 | 2016-11-06 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71105 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.