Provider Demographics
NPI:1689463093
Name:KELLEY, NEIL
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:KELLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 BRANSFORD AVE APT 567
Mailing Address - Street 2:
Mailing Address - City:BERRY HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3296
Mailing Address - Country:US
Mailing Address - Phone:925-899-9433
Mailing Address - Fax:
Practice Address - Street 1:5203 MARYLAND WAY STE 104
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5022
Practice Address - Country:US
Practice Address - Phone:650-560-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician