Individual
MRS. KELLY ELIZABETH LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCABA
Contact information
Practice address
1025 E 54TH ST, INDIANAPOLIS, IN 46220-3219
(317) 815-5501
Mailing address
1025 E 54TH ST, INDIANAPOLIS, IN 46220-3219
(317) 815-5501
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0-15-6705
IN
Other
Enumeration date
10/12/2015
Last updated
10/12/2015
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