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General NPI Number Information
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NPI Number | 1770823429
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Entity Type | Organization
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Legal Business Name | KELLY ANN CONSULTING, LLC
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Dates
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Enumeration Date | 02/17/2013
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 1 GAPVIEW AVE
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City | BLAIRSTOWN
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State | NJ
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Zip | 07825-3530
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Country | US
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Telephone | 908-581-0786
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Fax | 908-459-4018
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Provider Business Mailing Address
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Address Line | PO BOX 24 10 BLAIRSTOWN ROAD
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City | HOPE
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State | NJ
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Zip | 07844-0024
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Country | US
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Telephone | 908-581-0786
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Fax | 908-459-4018
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Authorized Official
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Title or Position | OWNER
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Name | MS. KELLY ANN CARLILE
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Credential | MA, BCBA
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Telephone | 908-581-0786
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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 | 1-12-10172
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License Number State | NJ
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