Provider Demographics
NPI:1932920329
Name:MCNELIS SCHRODER, KELLY (LEP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MCNELIS SCHRODER
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 NEWBURY RD STE 1-209
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3452
Mailing Address - Country:US
Mailing Address - Phone:805-262-7732
Mailing Address - Fax:
Practice Address - Street 1:2749 MICHAEL DR
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3255
Practice Address - Country:US
Practice Address - Phone:530-514-3634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4560103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist