Provider Demographics
NPI:1346786415
Name:STROUD, KELSEY STARR (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:STARR
Last Name:STROUD
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:GRACE
Other - Last Name:STARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BCBA
Mailing Address - Street 1:751 E GEORGIA RD
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:SC
Mailing Address - Zip Code:29388-8787
Mailing Address - Country:US
Mailing Address - Phone:864-476-7400
Mailing Address - Fax:
Practice Address - Street 1:751 E GEORGIA RD
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-8787
Practice Address - Country:US
Practice Address - Phone:864-476-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-16-24713OtherBEHAVIOR ANALYST CERTIFICATION BOARD