Provider Demographics
NPI:1730481789
Name:KELLY TONELLI PSYCHOLOGIST A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KELLY TONELLI PSYCHOLOGIST A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-262-3248
Mailing Address - Street 1:10 CORPORATE PARK STE 215
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5199
Mailing Address - Country:US
Mailing Address - Phone:949-444-6486
Mailing Address - Fax:
Practice Address - Street 1:10 CORPORATE PARK STE 215
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5199
Practice Address - Country:US
Practice Address - Phone:949-444-6486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19248103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty