Provider Demographics
NPI:1770091928
Name:KELLEY, ALEXANDRA MICHELLE (BCBA, LBA - KS, MO)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MICHELLE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:BCBA, LBA - KS, MO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6517 NW GILLY RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-3816
Mailing Address - Country:US
Mailing Address - Phone:816-519-5632
Mailing Address - Fax:
Practice Address - Street 1:620 S ROGERS RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1704
Practice Address - Country:US
Practice Address - Phone:913-324-3817
Practice Address - Fax:913-324-3894
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11728401103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst