Kristen Ellis, MA, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-18-31644 Issued in CA

Practice address

9755 Lincoln Village Dr
Sacramento, CA 95827-3334

Phone

(916) 363-6103

Fax

(916) 244-0594

NPI assigned

Oct 11, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

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.

• Tidal Consulting & Therapy

  • Behavior Analyst
  • Salisbury, MD
  • NPI 1063175883
  NPD Authorized official
• Advance Kids

  • Behavior Analyst
  • Sacramento, CA
  • NPI 1366674210
  NPD (past)
• Advance Kids

  • Behavior Analyst
  • Sacramento, CA
  • NPI 1831079615
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1539216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539216000000",
    "number": "1255806626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9755 LINCOLN VILLAGE DR",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958273334",
            "telephone_number": "916-363-6103",
            "fax_number": "916-244-0594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9755 LINCOLN VILLAGE DR",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958273334",
            "telephone_number": "916-363-6103",
            "fax_number": "916-244-0594"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2800 Stonecreek Dr",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958331634",
            "country_code": "US",
            "telephone_number": "916-363-6103",
            "fax_number": "916-244-0594",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "KRISTEN",
        "credential": "MA, BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-11",
        "last_updated": "2018-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-18-31644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Collin Ellis
• Cora Ellis
• Destinee Audrey Ellis
• Erika Marie Ellis, MD, PHD
• Gavin Alexander Ellis
• Lia Ellis
• Linda Ann Ellis, R.N., M.N.
• Megan Ellis
• Megan Marie Kirnon Ellis, LMFT
• Tanisha Ellis

• Behavior Analyst in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.