Provider Demographics
NPI:1134677107
Name:BURNETTE, KELSEY L (BCABA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:L
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 MURFREESBORO PIKE STE 702
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-2679
Mailing Address - Country:US
Mailing Address - Phone:615-577-5694
Mailing Address - Fax:615-577-5654
Practice Address - Street 1:1123 QUEENSBOROUGH BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-352-7049
Practice Address - Fax:803-905-4431
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst