Provider Demographics
NPI:1538471859
Name:BELL, ALLYSON RENE (BCABA)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:RENE
Last Name:BELL
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:RENE
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4165
Mailing Address - Country:US
Mailing Address - Phone:316-308-4184
Mailing Address - Fax:316-634-8850
Practice Address - Street 1:1650 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4165
Practice Address - Country:US
Practice Address - Phone:316-308-4184
Practice Address - Fax:316-352-9315
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0125123103K00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200610020AMedicaid