Provider Demographics
NPI:1033505466
Name:BATTAGLIA, KELLY (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:BATTAGLIA
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:JEAN
Other - Last Name:BATTAGLIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:45445 PORTOLA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4844
Mailing Address - Country:US
Mailing Address - Phone:760-385-3959
Mailing Address - Fax:
Practice Address - Street 1:45445 PORTOLA AVE STE 1
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4844
Practice Address - Country:US
Practice Address - Phone:760-895-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86123106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist