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NPI Code Detail

MEDICARE: KATELYNN ROSE KELLEY BCBA, LBA

MEDICARE: KATELYNN ROSE KELLEY BCBA, LBA
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
1106S00000XBehavior Technician
2103K00000XBehavior AnalystLBA0888NV

General Provider Information

NPI Number : 1538703723
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATELYNN ROSE KELLEY BCBA, LBA
Provider Business Mailing Address
First Line : 9074 GLENNON AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-2642
Country : US
Telephone Number : 385-666-8990
Fax Number :
Provider Business Practice Location Address
First Line : 1707 VILLAGE CENTER CIR STE 140
Second Line :
City : LAS VEGAS
State : NV
Zip : 89134-0577
Country : US
Telephone Number : 702-766-9840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2019
Last Update Date : 05/09/2024

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