Provider Demographics
NPI:1811648116
Name:RAY, KELSEY (BCBA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:RAY
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 EASTWOOD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1873
Mailing Address - Country:US
Mailing Address - Phone:346-500-5842
Mailing Address - Fax:
Practice Address - Street 1:5500 MURRELL RD STE 100
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-6700
Practice Address - Country:US
Practice Address - Phone:321-426-7759
Practice Address - Fax:321-593-0839
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-176351106S00000X
NC1-25-80994103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician