Provider Demographics
NPI:1477920478
Name:RUGLESS, KELLI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:
Last Name:RUGLESS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 WILSHIRE BLVD STE 700C
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3105
Mailing Address - Country:US
Mailing Address - Phone:310-954-2002
Mailing Address - Fax:
Practice Address - Street 1:8500 WILSHIRE BLVD STE 700C
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3105
Practice Address - Country:US
Practice Address - Phone:310-954-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2020-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05585103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical