Provider Demographics
NPI:1538703723
Name:KELLEY, KATELYNN ROSE (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KATELYNN
Middle Name:ROSE
Last Name:KELLEY
Suffix:
Gender:X
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:KAEGEN
Other - Middle Name:R
Other - Last Name:HIGGINBOTHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA, LBA
Mailing Address - Street 1:9074 GLENNON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2642
Mailing Address - Country:US
Mailing Address - Phone:385-666-8990
Mailing Address - Fax:
Practice Address - Street 1:1707 VILLAGE CENTER CIR STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-0577
Practice Address - Country:US
Practice Address - Phone:702-766-9840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NVLBA0888103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician