Provider Demographics
NPI:1538434857
Name:KELLEY, KRISTEN NOELL (PHD, BCBA)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:NOELL
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 O STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521
Mailing Address - Country:US
Mailing Address - Phone:707-826-0872
Mailing Address - Fax:707-826-0874
Practice Address - Street 1:901 O STREET
Practice Address - Street 2:SUITE C
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521
Practice Address - Country:US
Practice Address - Phone:707-826-0872
Practice Address - Fax:707-826-0874
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-09-5186103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609198175OtherCOMPANY NPI