Basic Information
| Provider Information | |||||||||
| NPI: | 1851905715 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | KELSEY | ||||||||
| MiddleName: | LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 390 UNION BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802286514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039898172 | ||||||||
| FaxNumber: | 3039844366 | ||||||||
| Practice Location | |||||||||
| Address1: | 6369 E TANQUE VERDE RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857153833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202761274 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2020 | ||||||||
| LastUpdateDate: | 09/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | BEH-000548 | AZ | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.