Provider Demographics
NPI:1639508179
Name:MONTIEL, KELLY E (BCBA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:E
Last Name:MONTIEL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3954 MURPHY CANYON RD
Mailing Address - Street 2:SUITE D105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4418
Mailing Address - Country:US
Mailing Address - Phone:858-569-0056
Mailing Address - Fax:858-569-4233
Practice Address - Street 1:3954 MURPHY CANYON RD
Practice Address - Street 2:SUITE D105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4418
Practice Address - Country:US
Practice Address - Phone:858-569-0056
Practice Address - Fax:858-569-4233
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-14546103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst