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NPI Code Detail

MEDICARE: KELLEN KERRY COLE

MEDICARE: KELLEN KERRY COLE
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 TechnicianCA
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1679075246
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLEN KERRY COLE
Provider Business Mailing Address
First Line : 21600 OXNARD ST STE 1800
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-7807
Country : US
Telephone Number : 818-345-2345
Fax Number :
Provider Business Practice Location Address
First Line : 1210 CENTRAL BLVD STE A
Second Line :
City : BRENTWOOD
State : CA
Zip : 94513-2379
Country : US
Telephone Number : 925-809-6565
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2018
Last Update Date : 02/28/2018

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Directions to “ KELLEN KERRY COLE ” Practice Location

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