Kellems, Andy Burl
Kellems, Andy Burl is an sole proprietor health care provider with primary practice located at 3151 Airway Ave Ste F107 , Costa Mesa CA 92626-4623. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Kellems, Andy Burl can be contacted via phone (714) 964-6730.Contact Information
Primary practice address
3151 Airway Ave Ste F107
Costa Mesa CA 92626-4623
Phone: (714) 964-6730
Fax: (714) 964-4382
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 081486 | California |
Profile Details
| NPI number | 1639556673 |
|---|---|
| LBN Legal business name | Kellems, Andy Burl |
| Credentials | CADC |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 29th, 2015 |
| Last updated | Apr 29th, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639556673 | NPPES |
| California | Other | 081486 | CAADE |
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