Provider Demographics
NPI:1730895624
Name:EMMONS, KODY LEANN
Entity type:Individual
Prefix:MRS
First Name:KODY
Middle Name:LEANN
Last Name:EMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 ELDORADO PKWY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-7438
Mailing Address - Country:US
Mailing Address - Phone:214-550-7011
Mailing Address - Fax:
Practice Address - Street 1:2831 ELDORADO PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-7438
Practice Address - Country:US
Practice Address - Phone:214-550-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician