Provider Demographics
NPI:1669002523
Name:KELLIS, NATASHA (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:KELLIS
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-4547
Mailing Address - Country:US
Mailing Address - Phone:832-769-9086
Mailing Address - Fax:
Practice Address - Street 1:507 AURORA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2329
Practice Address - Country:US
Practice Address - Phone:832-769-9086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3181103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-19-40400OtherBACB
TX3181OtherTEXAS LISCENSE BEHAVIOR ANALYST