MEDICARE: MAHBOUCHU KELLY

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
1	106S00000X	Behavior Technician
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1740137231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHBOUCHU KELLY

Provider Business Mailing Address
First Line	:	2000 TOWER OAKS BLVD STE 500
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20852-4377
Country	:	US
Telephone Number	:	301-444-5001
Fax Number	:

Provider Business Practice Location Address
First Line	:	6323 GEORGIA AVE NW STE 360
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-1101
Country	:	US
Telephone Number	:	202-621-8494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	04/28/2026

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Directions to “ MAHBOUCHU KELLY ” Practice Location

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