Provider Demographics
NPI:1689132847
Name:KELLS, TONI SUE (AMFT, LAADC)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:SUE
Last Name:KELLS
Suffix:
Gender:F
Credentials:AMFT, LAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8615 HALDEMAN ST
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-2636
Mailing Address - Country:US
Mailing Address - Phone:323-427-7001
Mailing Address - Fax:
Practice Address - Street 1:6628 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4617
Practice Address - Country:US
Practice Address - Phone:818-646-0134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCI10770218101YA0400X
CA104690106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)