Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | LEP3257 | CA |
Y | 103T00000X | Psychologist | LEP3257 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103TM1800X | Intellectual & Developmental Disabilities |
NPI | 1083287957 |
---|---|
Provider Name | Dr. Maya Kelly |
First Address | Woodland Hills, CA 91367-3927 |
Second Address | Sherman Oaks, CA 91403-3009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2021 |
Last Update Date | 20/07/2021 |