Provider Demographics
NPI:1033674965
Name:WEBB, KELSIE NICOLE (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:NICOLE
Last Name:WEBB
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:KELSIE
Other - Middle Name:NICOLE
Other - Last Name:THURMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA, LBA
Mailing Address - Street 1:300 INTERNATIONAL PARKWAY SUITE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5028
Mailing Address - Country:US
Mailing Address - Phone:629-216-2007
Mailing Address - Fax:
Practice Address - Street 1:131 HATCHER LANE
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:629-216-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IARBT-19-76901106S00000X
TN820103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ070622Medicaid