Active NPI
Scott Kelley
- Behavior Technician
- Fort Wayne, IN
National Provider Identifier
1215656327
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 201 E Rudisill Blvd Ste B100
Fort Wayne, IN 46806-1738 - Phone
- (260) 255-3665
- Fax
- (266) 255-3594
- NPI assigned
- Aug 23, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
201 E Rudisill Blvd Ste B100
Fort Wayne, IN 46806-1738
Mailing address
1333 S Mayflower Ave Ste 220
Monrovia, CA 91016-5239
Phone (260) 440-0668
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Great Heights ABA Inc. | Behavior Technician | Current | Accepting new patients |
Locations
201 E Rudisill Blvd
Ste B100
Fort Wayne, IN 46806
Phone (260) 255-3665
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733875200000",
"number": "1215656327",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1333 S MAYFLOWER AVE STE 220",
"city": "MONROVIA",
"state": "CA",
"postal_code": "910165239",
"telephone_number": "260-440-0668"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 E RUDISILL BLVD STE B100",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468061738",
"telephone_number": "260-255-3665",
"fax_number": "266-255-3594"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "SCOTT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-23",
"last_updated": "2024-12-11",
"certification_date": "2024-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 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.