Basic Information
| Provider Information | |||||||||
| NPI: | 1336621200 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POUNDS | ||||||||
| FirstName: | KAYLA | ||||||||
| MiddleName: | REA | ||||||||
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| Credential: | M.S., BCBA | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6004 WALDEN DR | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379196370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8657665775 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6004 WALDEN DR | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379196370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8657665775 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2018 | ||||||||
| LastUpdateDate: | 03/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 190087 | MS | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103K00000X | 910 | TN | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 04827599 | 05 | MS | MEDICAID |