Provider Demographics
NPI:1407070386
Name:TONELLI, KELLY L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:L
Last Name:TONELLI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:HELENE
Other - Last Name:LYTTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 CORPORATE PARK STE 215
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5199
Mailing Address - Country:US
Mailing Address - Phone:949-444-6486
Mailing Address - Fax:949-444-6486
Practice Address - Street 1:10 CORPORATE PARK STE 215
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5199
Practice Address - Country:US
Practice Address - Phone:949-444-6486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19248103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical