Provider Demographics
NPI:1902615347
Name:MURPHY, KELLY JO (RBT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JO
Last Name:MURPHY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1436 BOSTON LN SW
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-4502
Mailing Address - Country:US
Mailing Address - Phone:515-330-8467
Mailing Address - Fax:
Practice Address - Street 1:1625 ADVENTURELAND DR STE 2
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-2237
Practice Address - Country:US
Practice Address - Phone:515-967-4369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IARBT-24-397080106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician