Provider Demographics
NPI:1225359490
Name:WITT, KELLE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:KELLE
Middle Name:
Last Name:WITT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21007 E AVENIDA DEL VALLE
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-4866
Mailing Address - Country:US
Mailing Address - Phone:850-819-3727
Mailing Address - Fax:
Practice Address - Street 1:21007 E AVENIDA DEL VALLE
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-4866
Practice Address - Country:US
Practice Address - Phone:850-819-3727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst