Provider Demographics
NPI:1063619450
Name:QUINLAN, KELLI ANNE
Entity type:Individual
Prefix:MS
First Name:KELLI
Middle Name:ANNE
Last Name:QUINLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3654 KINGS WAY
Mailing Address - Street 2:#1
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-6437
Mailing Address - Country:US
Mailing Address - Phone:916-971-9983
Mailing Address - Fax:
Practice Address - Street 1:2220 WATT AVE
Practice Address - Street 2:BLDG B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0512
Practice Address - Country:US
Practice Address - Phone:916-485-6500
Practice Address - Fax:916-485-6814
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health