Provider Demographics
NPI:1891177168
Name:FELSHEIM, KRYSTYN (BCABA)
Entity Type:Individual
Prefix:
First Name:KRYSTYN
Middle Name:
Last Name:FELSHEIM
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:KRYSTYN
Other - Middle Name:
Other - Last Name:MCALLISTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCABA
Mailing Address - Street 1:15 SEXTANT DR
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-1610
Mailing Address - Country:US
Mailing Address - Phone:732-430-5209
Mailing Address - Fax:
Practice Address - Street 1:15 SEXTANT DR
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-1610
Practice Address - Country:US
Practice Address - Phone:732-430-5209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0-14-6422103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0-14-6422OtherBEHAVIOR ANALYST CERTIFICATION BOARD