MEDICARE: KELLY LYNN BILLINGS CBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	CB61148327	WA

General Provider Information

NPI Number	:	1386345759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY LYNN BILLINGS CBT

Provider Business Mailing Address
First Line	:	2327 SE KELBY CIR
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-5556
Country	:	US
Telephone Number	:	701-500-0944
Fax Number	:

Provider Business Practice Location Address
First Line	:	2327 SE KELBY CIR
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-5556
Country	:	US
Telephone Number	:	170-150-0094
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	03/13/2023

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