Provider Demographics
NPI:1396208344
Name:TERRELL, KYLEE-ANN FAITH
Entity Type:Individual
Prefix:
First Name:KYLEE-ANN
Middle Name:FAITH
Last Name:TERRELL
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 1:1869 LACASSIE AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596
Mailing Address - Country:US
Mailing Address - Phone:916-283-1634
Mailing Address - Fax:500-800-2156
Practice Address - Street 1:5820 STONERIDGE MALL RD SUITE 205
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588
Practice Address - Country:US
Practice Address - Phone:877-418-2978
Practice Address - Fax:500-800-2186
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician