Provider Demographics
NPI:1114718756
Name:TINKER, KELSIE (RBT)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:
Last Name:TINKER
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 W CROSS ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-8754
Mailing Address - Country:US
Mailing Address - Phone:765-729-6258
Mailing Address - Fax:
Practice Address - Street 1:810 W 53RD ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-1516
Practice Address - Country:US
Practice Address - Phone:765-617-2279
Practice Address - Fax:765-274-5260
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-25-418005106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician