Provider Demographics
NPI:1427297555
Name:SEOLAS, KELLY ERMA
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ERMA
Last Name:SEOLAS
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 1:710 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-4938
Mailing Address - Country:US
Mailing Address - Phone:530-894-5933
Mailing Address - Fax:530-894-5791
Practice Address - Street 1:710 WALNUT ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-4938
Practice Address - Country:US
Practice Address - Phone:530-894-5933
Practice Address - Fax:530-894-5791
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical