Provider Demographics
NPI:1295164242
Name:ARENS WHICKER, KELLY JEAN (MA, LCPC, BCBA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:ARENS WHICKER
Suffix:
Gender:F
Credentials:MA, LCPC, BCBA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:ARENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LCPC, BCBA
Mailing Address - Street 1:19 COUNTRY PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5311
Mailing Address - Country:US
Mailing Address - Phone:812-483-8096
Mailing Address - Fax:
Practice Address - Street 1:19 COUNTRY PL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5311
Practice Address - Country:US
Practice Address - Phone:812-483-8096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-09
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004068101YM0800X, 101YP2500X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst