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General NPI Number Information
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NPI Number | 1467004861
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Entity Type | Individual
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Provider Name | CARA KELSO M.A., BCBA
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Gender | Female
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Dates
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Enumeration Date | 07/15/2019
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Last Update Date | 07/15/2019
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Provider Practice Location Address
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Address Line | 305 W BROADWAY AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-1238
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Country | US
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Telephone | 817-846-3671
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Fax |
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Provider Business Mailing Address
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Address Line | 2202 FULWILER RD
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City | ABILENE
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State | TX
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Zip | 79603-7710
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Country | US
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Telephone | 817-846-3671
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-13-13071
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License Number State | TX
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