Provider Demographics
NPI:1477115558
Name:BRUINGTON, KELLI MARIE (MED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:MARIE
Last Name:BRUINGTON
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:M
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:125 REARDON BLVD
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2034
Mailing Address - Country:US
Mailing Address - Phone:502-507-0933
Mailing Address - Fax:
Practice Address - Street 1:125 REARDON BLVD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2034
Practice Address - Country:US
Practice Address - Phone:502-507-0933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251737103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-19-36182OtherBCBA CERTIFICATE