Individual
TAYLOR NICOLE KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA
Contact information
Practice address
21 S PARK BLVD STE 21, GREENWOOD, IN 46143-8838
(317) 449-2104
(317) 520-8200
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
(317) 520-8200
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-39001
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-19-39001
BCBA CERTIFICATE
—
Enumeration date
11/29/2019
Last updated
07/10/2020
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