Tiffany Kelly, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

LBA002919 Issued in GA

Practice address

107 Industrial Dr Ste E
Saint Marys, GA 31558-4436

Phone

(912) 324-5012

Fax

(912) 576-7075

NPI assigned

Sep 7, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Supportive Community Innovations

  • Behavior Analyst
  • Nashville, IN
  • NPI 1902265267
  NPD (past)

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

{
    "created_epoch": "1662508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789862400000",
    "number": "1669193843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 CAMBRAY CIR",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315583502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 INDUSTRIAL DR STE E",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315584436",
            "telephone_number": "912-324-5012",
            "fax_number": "912-576-7075"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10545 Colerain Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Marys",
            "state": "GA",
            "postal_code": "315583720",
            "country_code": "US",
            "telephone_number": "912-266-8686",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "TIFFANY",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-07",
        "last_updated": "2026-09-20",
        "certification_date": "2026-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "GA",
            "license": "LBA002919",
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "VA",
            "license": "0133005355",
            "primary": false
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "IN",
            "license": "RBT-22-206597",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Whitney A Johnson, OTA
• Destiny Johnston, RBT
• Brianna Kathryn Jones
• Kashanna R Jones
• Harley-Dee Keels
• Susan Elizabeth Kenyon, MSW, LCSW
• Anthony Lee Kicklighter, RPH.
• Bree-Ann King
• Janine C King, OTR/L
• Kellie King, PMHNP-BC

• Behavior Analyst in Saint Marys, GA
• Providers in Saint Marys, GA by specialty
• Behavior Analyst in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2026; 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.