Provider Demographics
NPI:1598936171
Name:HYNDS, KELLIE MARIE (MA)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:MARIE
Last Name:HYNDS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 BURL DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-1117
Mailing Address - Country:US
Mailing Address - Phone:951-686-5034
Mailing Address - Fax:
Practice Address - Street 1:3511 BURL DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1117
Practice Address - Country:US
Practice Address - Phone:951-686-5034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51287106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist