Provider Demographics
NPI:1114369014
Name:MURPHY, KELSEY ANN (MA, BCBA)
Entity Type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:ANN
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 W 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6515
Mailing Address - Country:US
Mailing Address - Phone:248-837-2068
Mailing Address - Fax:248-837-2068
Practice Address - Street 1:4410 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6515
Practice Address - Country:US
Practice Address - Phone:248-837-2068
Practice Address - Fax:248-837-2068
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-13-14044103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38-1359084OtherHEALTH ALLIANCE PLAN
MI38-1359084OtherBLUE CARE NETWORK
MI38-1359084OtherUNITED HEATHCARE
MI38-1359084OtherOPTUM
MI38-1359084OtherBLUE CROSS BLUE SHIELD
MI38-1359084OtherUNITED BEHAVIORAL HEALTH