Provider Demographics
NPI:1265977417
Name:HAWES, KELSEY CHALMERS (BCBA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:CHALMERS
Last Name:HAWES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:IRIS
Other - Last Name:CHALMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2944
Mailing Address - Country:US
Mailing Address - Phone:407-619-1581
Mailing Address - Fax:
Practice Address - Street 1:1717 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2944
Practice Address - Country:US
Practice Address - Phone:407-619-1581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-19-36375103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019549400Medicaid