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NPI Code Detail

MEDICARE: TIFFANY KELLY BCBA

MEDICARE: TIFFANY KELLY BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior AnalystLBA002919GA
2103K00000XBehavior Analyst0133005355VA
3106E00000XAssistant Behavior Analyst
4106S00000XBehavior TechnicianRBT-22-206597IN

General Provider Information

NPI Number : 1669193843
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY KELLY BCBA
Provider Business Mailing Address
First Line : 10545 COLERAIN RD
Second Line :
City : SAINT MARYS
State : GA
Zip : 31558-3720
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10545 COLERAIN RD
Second Line :
City : SAINT MARYS
State : GA
Zip : 31558-3720
Country : US
Telephone Number : 912-266-8686
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2022
Last Update Date : 06/25/2026

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Directions to “ TIFFANY KELLY BCBA” Practice Location

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