Healthcare Provider Details

I. General information

NPI: 1275092819
Provider Name (Legal Business Name): KELSEY PHAM BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33761 DIANA DR
DANA POINT CA
92629-2308
US

IV. Provider business mailing address

33761 DIANA DR
DANA POINT CA
92629-2308
US

V. Phone/Fax

Practice location:
  • Phone: 949-527-8880
  • Fax:
Mailing address:
  • Phone: 949-527-8880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: