Provider Demographics
NPI:1164832358
Name:BAND, KELLIE (DBH, BCBA, LBA)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:
Last Name:BAND
Suffix:
Gender:F
Credentials:DBH, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4822 E FERNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-6392
Mailing Address - Country:US
Mailing Address - Phone:602-558-1689
Mailing Address - Fax:
Practice Address - Street 1:4822 E FERNWOOD CT
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-6392
Practice Address - Country:US
Practice Address - Phone:602-558-1689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBA-114103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1164832358OtherNPI