Active NPI
Kelsey Rae Goodner
- Behavior Analyst
- Phoenix, AZ
National Provider Identifier
1205425758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- BEH-001413
- Practice address
- 4350 E Muirwood Dr Ste 130
Phoenix, AZ 85048-8807 - Phone
- (480) 610-6981
- Fax
- (480) 898-7419
- NPI assigned
- Jan 11, 2021
- Reactivated
- Nov 22, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Behavior Analyst | 103K00000X | BEH-001413 | AZ | Primary |
Addresses
Primary practice location
4350 E Muirwood Dr Ste 130
Phoenix, AZ 85048-8807
Mailing address
1546 N Parkway Dr
Gilbert, AZ 85234-5412
Phone (480) 716-1414
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BEH-001413 | AZ | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Total Care ABA Az LLC | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Behavior Analyst
- Scottsdale, AZ
- NPI 1659030955
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733097600000",
"number": "1205425758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1546 N PARKWAY DR",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852345412",
"telephone_number": "480-716-1414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4350 E MUIRWOOD DR STE 130",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850488807",
"telephone_number": "480-610-6981",
"fax_number": "480-898-7419"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODNER",
"first_name": "KELSEY",
"middle_name": "RAE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-01-11",
"last_updated": "2024-12-02",
"certification_date": "2024-12-02",
"deactivation_date": "2024-10-20",
"reactivation_date": "2024-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "AZ",
"license": "BEH-001413",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.