Provider Demographics
NPI:1972942142
Name:TOWNSEND, KELSEY (MED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 NW 169TH PL STE C100
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7362
Mailing Address - Country:US
Mailing Address - Phone:503-747-2587
Mailing Address - Fax:503-746-6323
Practice Address - Street 1:1800 NW 169TH PL
Practice Address - Street 2:STE A300
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4848
Practice Address - Country:US
Practice Address - Phone:503-747-2587
Practice Address - Fax:503-746-6323
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-B-10168550103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500691619Medicaid