Basic Information
| Provider Information | |||||||||
| NPI: | 1841336971 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLY-WARNER | ||||||||
| FirstName: | LAREE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 76510 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809706510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196388844 | ||||||||
| FaxNumber: | 7196388115 | ||||||||
| Practice Location | |||||||||
| Address1: | 1322 N ACADEMY BLVD STE 204 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809093320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196388844 | ||||||||
| FaxNumber: | 7196388115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 05/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YS0200X | 1062879 | CO | N | Behavioral Health & Social Service Providers | Counselor | School | 103K00000X | 1-06-2879 | CO | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.