Healthcare Provider Details

I. General information

NPI: 1639419344
Provider Name (Legal Business Name): KELLEY LEIGH COLLINS MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 S BUSINESS 31
PERU IN
46970-7188
US

IV. Provider business mailing address

612 E BOULEVARD
KOKOMO IN
46902-2271
US

V. Phone/Fax

Practice location:
  • Phone: 765-460-5071
  • Fax:
Mailing address:
  • Phone: 765-460-5071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-59626
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: