Individual
MANNY BRICE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPT
Contact information
Practice address
1481 WINDSOR DR, SAN BERNARDINO, CA 92404-5416
(909) 361-6472
(909) 203-7403
Mailing address
2895 W FAIRVIEW DR, RIALTO, CA 92377-3425
(909) 435-5341
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
33817
CA
Other
Enumeration date
04/22/2019
Last updated
04/22/2019
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