Provider Demographics
NPI:1306535513
Name:VENABLE, KELIYA
Entity type:Individual
Prefix:
First Name:KELIYA
Middle Name:
Last Name:VENABLE
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 1:3328 TUALATIN WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6957
Mailing Address - Country:US
Mailing Address - Phone:916-241-5191
Mailing Address - Fax:
Practice Address - Street 1:3336 BRADSHAW RD STE 215
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2624
Practice Address - Country:US
Practice Address - Phone:916-300-6576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist