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NPI Code Detail

MEDICARE: MRS. LAREE C KELLY-WARNER MA, BCBA

MEDICARE: MRS. LAREE C KELLY-WARNER MA, 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
1101YS0200XSchool Counselor1062879CO
2103K00000XBehavior Analyst1-06-2879CO

General Provider Information

NPI Number : 1841336971
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAREE C KELLY-WARNER MA, BCBA
Provider Business Mailing Address
First Line : PO BOX 76510
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80970-6510
Country : US
Telephone Number : 719-638-8844
Fax Number : 719-638-8115
Provider Business Practice Location Address
First Line : 1322 N ACADEMY BLVD STE 204
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80909-3320
Country : US
Telephone Number : 719-638-8844
Fax Number : 719-638-8115
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2007
Last Update Date : 05/23/2022

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