Provider Demographics
NPI:1639653215
Name:BECK, KELLI MICHELLE (BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:MICHELLE
Last Name:BECK
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 RIDGECREST LOOP
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-6048
Mailing Address - Country:US
Mailing Address - Phone:229-854-1545
Mailing Address - Fax:
Practice Address - Street 1:2363 S BRANNON STAND RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-7005
Practice Address - Country:US
Practice Address - Phone:334-618-6809
Practice Address - Fax:334-801-0516
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst