Provider Demographics
NPI:1679258313
Name:LAYE, KELLI RENEE
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:RENEE
Last Name:LAYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:RENEE
Other - Last Name:LAYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:N/A
Mailing Address - Street 1:OPTIMAL BEHAVIORAL SUPPORT SERVICES, LLC
Mailing Address - Street 2:4700 WICHERS DRIVE, SUITE 206
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072
Mailing Address - Country:US
Mailing Address - Phone:504-645-5506
Mailing Address - Fax:888-400-9860
Practice Address - Street 1:OPTIMAL BEHAVIORAL SUPPORT SERVICES, LLC
Practice Address - Street 2:4700 WICHERS DRIVE, SUITE 206
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-645-5506
Practice Address - Fax:888-400-9860
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator