Healthcare Provider Details

I. General information

NPI: 1932733417
Provider Name (Legal Business Name): DONNA KELLY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41690 ENTERPRISE CIR N STE 114
TEMECULA CA
92590-5617
US

IV. Provider business mailing address

41690 ENTERPRISE CIR N STE 114
TEMECULA CA
92590-5617
US

V. Phone/Fax

Practice location:
  • Phone: 951-667-9631
  • Fax:
Mailing address:
  • Phone: 951-667-9631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: