Provider Demographics
NPI:1730705492
Name:GABRIEL, KARLIE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:KARLIE
Middle Name:
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 CEDAR RUN DR
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-7523
Mailing Address - Country:US
Mailing Address - Phone:765-210-9060
Mailing Address - Fax:
Practice Address - Street 1:125 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4554
Practice Address - Country:US
Practice Address - Phone:765-419-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-20-42713103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst