Provider Demographics
NPI:1255002259
Name:PERKINS, KELLIE A
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:A
Last Name:PERKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 MONTAIR DR
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:CA
Mailing Address - Zip Code:96064-9200
Mailing Address - Country:US
Mailing Address - Phone:530-643-2439
Mailing Address - Fax:
Practice Address - Street 1:2580 VICTOR AVE STE C
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1455
Practice Address - Country:US
Practice Address - Phone:530-722-9092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist