Provider Demographics
NPI:1467004861
Name:KELSO, CARA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:KELSO
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 FULWILER RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79603-7710
Mailing Address - Country:US
Mailing Address - Phone:817-846-3671
Mailing Address - Fax:
Practice Address - Street 1:305 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1238
Practice Address - Country:US
Practice Address - Phone:817-846-3671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-13-13071103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst