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General NPI Number Information
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NPI Number | 1003278797
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Entity Type | Individual
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Provider Name | DEBRA A. KELLY MFT, BCBA
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Gender | Female
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 23351 MADERO STE 292
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City | MISSION VIEJO
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State | CA
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Zip | 92691-2730
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Country | US
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Telephone | 949-335-0254
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Fax | 949-388-3310
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Provider Business Mailing Address
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Address Line | 8787 COMPLEX DR STE 300
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City | SAN DIEGO
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State | CA
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Zip | 92123-1453
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Country | US
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Telephone | 197-971-0906
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Fax | 858-444-8827
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 12258842
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 35691
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License Number State | CA
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