1467881466 NPI number — KELLEE CHI BCBA

Table of content: KELLEE CHI BCBA (NPI 1467881466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467881466 NPI number — KELLEE CHI BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHI
Provider First Name:
KELLEE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467881466
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19019 VENTURA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TARZANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91356-3253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-345-2345
Provider Business Mailing Address Fax Number:
818-758-8015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 E HILLCREST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THOUSAND OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91360-5828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-379-4000
Provider Business Practice Location Address Fax Number:
805-435-7440
Provider Enumeration Date:
11/11/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-13-14347 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)