Provider Demographics
NPI:1043785660
Name:MYERS, KELSEY (BCBA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 NAPERVILLE RD STE 265
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3486
Mailing Address - Country:US
Mailing Address - Phone:331-457-5533
Mailing Address - Fax:
Practice Address - Street 1:730 PEACHTREE ST NE STE 570
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1244
Practice Address - Country:US
Practice Address - Phone:630-639-7247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-18-32209103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst