Provider Demographics
NPI:1174852503
Name:RICH, KELLE WOOD (MED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KELLE
Middle Name:WOOD
Last Name:RICH
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3006 BEE CAVES ROAD
Mailing Address - Street 2:STE B-200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-328-5599
Mailing Address - Fax:512-328-5585
Practice Address - Street 1:3006 BEE CAVES ROAD
Practice Address - Street 2:STE B-200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-328-5599
Practice Address - Fax:512-328-5585
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000216103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst