Healthcare Provider Details

I. General information

NPI: 1265775472
Provider Name (Legal Business Name): ARIANA KELLY GILLESPIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 LA SOLIDAD WAY
SACRAMENTO CA
95820-1341
US

IV. Provider business mailing address

900 FULTON AVE 205
SACRAMENTO CA
95825-4500
US

V. Phone/Fax

Practice location:
  • Phone: 818-505-4657
  • Fax:
Mailing address:
  • Phone: 916-484-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: