Provider Demographics
NPI:1194223123
Name:HALL, KELSIE (BHT)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:BHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BELLA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1879
Mailing Address - Country:US
Mailing Address - Phone:717-612-2282
Mailing Address - Fax:
Practice Address - Street 1:20 BELLA VISTA DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1879
Practice Address - Country:US
Practice Address - Phone:717-612-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARBT-16-24492106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARBT-16-24492OtherAPPLIED BEHAVIOR ANALYSIS - REGISTERED BEHAVIOR TECHNICIAN