Healthcare Provider Details

I. General information

NPI: 1740191287
Provider Name (Legal Business Name): KENDALL HAILEY KELLER M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 DOUGLAS BLVD STE 300
ROSEVILLE CA
95661-3850
US

IV. Provider business mailing address

10 DECLARATION DR
CHICO CA
95973-4931
US

V. Phone/Fax

Practice location:
  • Phone: 855-500-6463
  • Fax:
Mailing address:
  • Phone: 855-500-6463
  • Fax: 844-553-6337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number164901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: