Individual
KELLI BOUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
230 S NOLEN DR, SOUTHLAKE, TX 76092-8078
(817) 402-8250
Mailing address
4044 TWIN CREEKS DR, FORT WORTH, TX 76244-8874
(469) 323-7295
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
05/24/2024
Last updated
05/24/2024
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