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NPI Code Detail

MEDICARE: SKYE KELLINGSWORTH

MEDICARE: SKYE KELLINGSWORTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1033997127
Entity Type Code : Individual
Provider Name (Legal Business Name) : SKYE KELLINGSWORTH
Provider Business Mailing Address
First Line : 1055 MESA DR
Second Line :
City : CAMARILLO
State : CA
Zip : 93010-1345
Country : US
Telephone Number : 818-371-0086
Fax Number :
Provider Business Practice Location Address
First Line : 501 MARIN ST STE 225
Second Line :
City : THOUSAND OAKS
State : CA
Zip : 91360-4301
Country : US
Telephone Number : 805-379-1401
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2023
Last Update Date : 12/09/2025

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Directions to “ SKYE KELLINGSWORTH ” Practice Location

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