Provider Demographics
NPI:1558898445
Name:MILLER, KELSEY (BCBA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MILLER
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 1:2301 BAGDAD RD STE 305
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-6503
Mailing Address - Country:US
Mailing Address - Phone:512-898-0944
Mailing Address - Fax:
Practice Address - Street 1:2301 S BAGDAD RD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78641-2309
Practice Address - Country:US
Practice Address - Phone:512-898-0944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-23268103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst