1295159135 NPI number — CHAMPIONS BEHAVIORAL HEALTH CARE

Table of content: DR. THERESA ANN KELLY PSY.D. (NPI 1477663763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295159135 NPI number — CHAMPIONS BEHAVIORAL HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHAMPIONS BEHAVIORAL HEALTH CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1295159135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
833 ASPEN PEAK LOOP UNIT 225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89011-1835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-894-8546
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
833 ASPEN PEAK LOOP UNIT 225
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89011-1835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-894-8546
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2014

Additional Information

Authorized Official

Authorized Official Last Name:
COOK
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
909-894-8546

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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