Healthcare Provider Details

I. General information

NPI: 1053174052
Provider Name (Legal Business Name): KELSEA FERENTHEIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 N 77TH ST
SCOTTSDALE AZ
85257-3708
US

IV. Provider business mailing address

1250 N 77TH ST
SCOTTSDALE AZ
85257-3708
US

V. Phone/Fax

Practice location:
  • Phone: 480-839-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-71929
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-178350
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: