Provider Demographics
NPI:1215614375
Name:KELLEY, WILLIE LEE III
Entity type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:LEE
Last Name:KELLEY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 CHANDLER CT APT 12
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-8203
Mailing Address - Country:US
Mailing Address - Phone:661-426-9367
Mailing Address - Fax:
Practice Address - Street 1:2600 CHANDLER CT APT 12
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-8203
Practice Address - Country:US
Practice Address - Phone:661-426-9367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician