Provider Demographics
NPI:1699344622
Name:BAIRD, KELLY (BCABA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BAIRD
Suffix:
Gender:
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 W BRANDON BLVD # 1268
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4717
Mailing Address - Country:US
Mailing Address - Phone:813-602-0068
Mailing Address - Fax:813-354-2715
Practice Address - Street 1:304 E PINE ST # 1252
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4969
Practice Address - Country:US
Practice Address - Phone:813-602-0068
Practice Address - Fax:813-354-2715
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-24-15514106E00000X, 106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst