Provider Demographics
NPI:1003407552
Name:CARRERO, KELLY M (PHD, BCBA, LBA-TX)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:M
Last Name:CARRERO
Suffix:
Gender:F
Credentials:PHD, BCBA, LBA-TX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4432 LONGFELLOW DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3217
Mailing Address - Country:US
Mailing Address - Phone:214-264-3069
Mailing Address - Fax:
Practice Address - Street 1:4432 LONGFELLOW DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3217
Practice Address - Country:US
Practice Address - Phone:214-264-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-14-16138103K00000X
TX1920103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty