Provider Demographics
NPI:1730443896
Name:HARRIS, KELSI A (MED, BCBA)
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3081 W 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-2707
Mailing Address - Country:US
Mailing Address - Phone:480-390-7641
Mailing Address - Fax:
Practice Address - Street 1:1724 MAJESTIC DR STE 109
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8510
Practice Address - Country:US
Practice Address - Phone:303-935-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-12-10400103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst