Provider Demographics
NPI:1306134226
Name:KRATZER, KELLY MARIE (BCBA)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MARIE
Last Name:KRATZER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17726 ALONZO PL STE 408
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4319
Mailing Address - Country:US
Mailing Address - Phone:310-570-1937
Mailing Address - Fax:
Practice Address - Street 1:19725 SHERMAN WAY STE 380
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-3661
Practice Address - Country:US
Practice Address - Phone:310-247-8712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83997106H00000X
CA1-08-4144103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist