Provider Demographics
NPI:1518937747
Name:BELL, KELLY LEE (MFT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LEE
Last Name:BELL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 MARSH ST STE 230
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2984
Mailing Address - Country:US
Mailing Address - Phone:805-904-6210
Mailing Address - Fax:805-975-0771
Practice Address - Street 1:1540 MARSH ST STE 230
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2984
Practice Address - Country:US
Practice Address - Phone:805-904-6210
Practice Address - Fax:805-975-0771
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CAMFC35054106H00000X
CALMFT35054106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770508983OtherTIN