Provider Demographics
NPI:1992568612
Name:NEUBECKER, KELLY ANNE (MS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:NEUBECKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27555 YNEZ RD STE 300
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4678
Mailing Address - Country:US
Mailing Address - Phone:951-694-0100
Mailing Address - Fax:
Practice Address - Street 1:27555 YNEZ RD STE 300
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4678
Practice Address - Country:US
Practice Address - Phone:951-694-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician