Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Keanu Boullon

Individual provider Behavior Technician · NPI 1144105982

Keanu Boullon is a Behavior Technician in Miami, Florida. Practices as a sole proprietor. Licensed in Florida.

Licensed in
FL
In the registry since
2025

Practice location Address checks out

12505 SW 28th St
Miami, FL 33175-2112
Phone: (786) 770-5813
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Behavior Technician (primary) Taxonomy 106S00000X · Licence BACB1331319 (FL)

Record details

NPI number1144105982
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedAugust 11, 2025
Last updated in NPPESAugust 11, 2025
Certification dateAugust 10, 2025
Mailing address12505 Sw 28th St, Miami, FL 33175-2112

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