Provider Demographics
NPI:1801314471
Name:CHELLI, MAXI
Entity type:Individual
Prefix:
First Name:MAXI
Middle Name:
Last Name:CHELLI
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 1:5225 NORTH LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:CARNELIAN BAY
Mailing Address - State:CA
Mailing Address - Zip Code:96140
Mailing Address - Country:US
Mailing Address - Phone:530-546-1921
Mailing Address - Fax:
Practice Address - Street 1:5225 NORTH LAKE BLVD
Practice Address - Street 2:
Practice Address - City:CARNELIAN BAY
Practice Address - State:CA
Practice Address - Zip Code:96140
Practice Address - Country:US
Practice Address - Phone:530-546-1921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker