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NPI Code Detail

MEDICARE: KEELY STEVENSON M.ED., BCBA

MEDICARE: KEELY STEVENSON M.ED., BCBA
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
1103K00000XBehavior Analyst1-08-4139TX

General Provider Information

NPI Number : 1497036594
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEELY STEVENSON M.ED., BCBA
Provider Business Mailing Address
First Line : 400 E ROYAL LN BLDG 3
Second Line : SUITE 290
City : IRVING
State : TX
Zip : 75039-3540
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Provider Business Practice Location Address
First Line : 400 E ROYAL LN BLDG 3
Second Line : SUITE 290
City : IRVING
State : TX
Zip : 75039-3540
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2011
Last Update Date : 05/11/2017

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