Provider Demographics
NPI:1104475326
Name:KELLNER, HANNAH MARIE
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:MARIE
Last Name:KELLNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 E LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-1555
Mailing Address - Country:US
Mailing Address - Phone:925-864-1290
Mailing Address - Fax:
Practice Address - Street 1:248 E LEWIS ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-1555
Practice Address - Country:US
Practice Address - Phone:925-864-1290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health