Provider Demographics
NPI:1134622145
Name:MAGEL, KELSEA ELIZABETH (MA, MS, BCBA, RBT)
Entity type:Individual
Prefix:
First Name:KELSEA
Middle Name:ELIZABETH
Last Name:MAGEL
Suffix:
Gender:F
Credentials:MA, MS, BCBA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6133
Mailing Address - Country:US
Mailing Address - Phone:720-449-6676
Mailing Address - Fax:
Practice Address - Street 1:1233 SHERMAN DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6133
Practice Address - Country:US
Practice Address - Phone:720-449-6676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-16-22140106S00000X
CO106S00000X
CO1-20-44611103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician