Active NPI
Kelly Hollis, RBT
- Behavior Technician
- Ste Genevieve, MO
National Provider Identifier
1366067845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- BACB550200
- Practice address
- 18384 Naeger LN
Ste Genevieve, MO 63670-9116 - Phone
- (573) 535-8315
- NPI assigned
- Jun 10, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | BACB550200 | MO | Primary |
Addresses
Primary practice location
18384 Naeger LN
Ste Genevieve, MO 63670-9116
Mailing address
8058 Fox Hollow
Barnhart, MO 63012
Phone (314) 939-7007
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 |
|---|---|---|---|
| BACB550200 | MO | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Behavioral Health at Home, LLC | 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
- Saint Mary, MO
- NPI 1235602285
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591747200000",
"number": "1366067845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8058 FOX HOLLOW",
"city": "BARNHART",
"state": "MO",
"postal_code": "63012",
"telephone_number": "314-939-7007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18384 NAEGER LN",
"city": "STE GENEVIEVE",
"state": "MO",
"postal_code": "636709116",
"telephone_number": "573-535-8315"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLIS",
"first_name": "KELLY",
"credential": "RBT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-10",
"last_updated": "2020-06-10",
"certification_date": "2020-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "MO",
"license": "BACB550200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ste Genevieve, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.