Individual
KELLY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1675 SW MARLOW AVE STE 200, PORTLAND, OR 97225-5102
(866) 523-4268
(510) 900-4310
Mailing address
4221 WILSHIRE BLVD STE 300A, LOS ANGELES, CA 90010-3537
(323) 556-3053
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
CA
Other
Enumeration date
09/23/2020
Last updated
10/26/2023
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