Individual
KRISTAN KEVIN SAN JUAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
200 TECHNOLOGY CT SE STE E, SMYRNA, GA 30082-5203
(770) 277-6293
(770) 288-0446
Mailing address
200 TECHNOLOGY CT SE STE E, SMYRNA, GA 30082-5203
(770) 277-6293
(770) 288-0446
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-56167
FL
103K00000X
Behavior Analyst
Primary
LBA002064
GA
106E00000X
Assistant Behavior Analyst
0-18-9202
FL
Other
Enumeration date
01/18/2019
Last updated
03/10/2026
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