Provider Demographics
NPI:1104474857
Name:DUNAWAY, KELSIE (BT)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:
Last Name:DUNAWAY
Suffix:
Gender:
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-9826
Mailing Address - Country:US
Mailing Address - Phone:214-628-0686
Mailing Address - Fax:
Practice Address - Street 1:710 N PRESTON RD
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-9826
Practice Address - Country:US
Practice Address - Phone:214-628-0686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-25-80607103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst