Provider Demographics
NPI:1497258313
Name:BATES, KELSEY (1-19-34797 BCBA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:1-19-34797 BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13333 NE BEL RED RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2332
Mailing Address - Country:US
Mailing Address - Phone:425-559-7809
Mailing Address - Fax:
Practice Address - Street 1:13333 NE BEL RED RD STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2332
Practice Address - Country:US
Practice Address - Phone:425-559-7809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-19-34797103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst