Provider Demographics
NPI:1699220830
Name:KELSEY, SARAH EMILY (BCBA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:EMILY
Last Name:KELSEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:EMILY
Other - Last Name:CAUSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7507 MICHIGAN RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-2321
Mailing Address - Country:US
Mailing Address - Phone:765-446-4185
Mailing Address - Fax:765-448-1864
Practice Address - Street 1:4370 WESTON POINTE DR STE 120&140
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-7202
Practice Address - Country:US
Practice Address - Phone:317-627-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-16-22740103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-16-22740OtherBOARD CERTIFICATION
IN300010161Medicaid