Provider Demographics
NPI:1528578622
Name:PRICE, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:PRICE
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 1:1446 WILD OLIVE RD
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-8987
Mailing Address - Country:US
Mailing Address - Phone:661-557-7152
Mailing Address - Fax:
Practice Address - Street 1:1446 WILD OLIVE RD
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-8987
Practice Address - Country:US
Practice Address - Phone:661-557-7152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician