Healthcare Provider Details

I. General information

NPI: 1134849516
Provider Name (Legal Business Name): KELSEY GRACE EVANS BCBA BEHAVIORANALYST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 BARRETT LAKES BLVD NW STE 520
KENNESAW GA
30144-4517
US

IV. Provider business mailing address

1701 BARRETT LAKES BLVD NW STE 520
KENNESAW GA
30144-4517
US

V. Phone/Fax

Practice location:
  • Phone: 470-750-1868
  • Fax:
Mailing address:
  • Phone: 470-750-1868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: