KELLY CANADY (NPI# 1902328578) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902328578 |
| Entity Type | Individual |
| Full Name | KELLY CANADY |
| Practice Address |
1100 N. D St. San Bernardino CA 92410 |
| Mailing Address |
1100 N D St San Bernardino CA 92410-3524 |
| Practice Telephone | 9093813774 |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2017-07-14 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| Street Address |
1100 N. D ST. |
| City | SAN BERNARDINO |
| State | CA |
| Zip Code | 92410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902303472 | Reina Elora Garcia | Student in an Organized Health Care Education/Training Program | 775 E Base Line St Spc 4, San Bernardino, CA 92410 | 2018-04-10 |
| 1558889881 | Salaunge Lopez | Non-emergency Medical Transport (VAN) | 25942 Baseline St Apt D203, San Bernardino, CA 92410 | 2017-09-07 |
| 1881058592 | Terron Thomas | Contractor | 445 South G, Unit B, San Bernardino, IN 92410 | 2016-04-08 |
| 1982064572 | Zachary Norton-martinez | Specialist/Technologist | 650 Del Rosa Dr, San Bernardino, CA 92410 | 2016-02-25 |
| 1003280934 | Brenda Boyle | Nurse Practitioner | 1455 East 3rd Street, San Bernardino, CA 92410 | 2015-11-16 |
| 1689045197 | Bryan Carter | Physician Assistant | 1455 E 3rd Street, San Bernardino, CA 92410 | 2015-10-09 |
| 1801270137 | Sac Health System | Clinic/Center | 250 South G Street, San Bernardino, CA 92410 | 2015-07-16 |
| 1467852269 | Wilson Dentistry, Inc. | Dentist | 1063 N. D St, San Bernardino, CA 92410 | 2014-08-28 |
| 1629405345 | Terrence John Forrester | Social Worker | 1455 E. 3rd St, San Bernardino, CA 92410 | 2013-09-27 |
| 1396095105 | Oswald Manuel Vargas | Marriage & Family Therapist | 1053 North D St, San Bernardino, CA 92410 | 2012-09-19 |
| Find all providers in zip 92410 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215547229 | Frank R Rivera | Counselor | 658 E Brier Dr Ste 350, San Bernardino, CA 92408-2875 | 2020-08-04 |
| 1528604501 | Rise Recovery | Counselor | 395 W 17th St, San Bernardino, CA 92405-4409 | 2019-11-25 |
| 1689210775 | Inland Empire Community Outreach Center | Counselor | 473 East Carnegie Drive, Suite 200, San Bernardino, CA 92408 | 2019-11-23 |
| 1881163434 | James Dean Anders | Counselor | 1481 Windsor Drive, San Bernardino, CA 92404 | 2018-11-13 |
| 1134644115 | Jorge Vasquez | Counselor | 222 W Hospitality Ln, San Bernardino, CA 92415-3536 | 2017-08-10 |
| 1477073377 | Mack William Tolle | Counselor | 321 E Carnegie Dr 210, San Bernardino, CA 92415-3012 | 2017-06-21 |
| 1093247215 | Traci Stockham | Counselor | 1925 W College Ave, Apt 185, San Bernardino, CA 92407-3371 | 2017-03-28 |
| 1760938534 | Michael Anthony Davis I | Counselor | 1475 E Date St Apt 118, San Bernardino, CA 92404-8227 | 2016-08-31 |
| 1770944704 | Cheryl Fox | Counselor | 560 N Arrowhead Ave Ste 1b, San Bernardino, CA 92401-1219 | 2016-03-18 |
| 1346600921 | Latasha Mcdonald | Counselor | 1365 North F Street, San Bernardino, CA 92405-0123 | 2016-02-25 |
| Find all providers in SAN BERNARDINO | ||||
| City | SAN BERNARDINO |
| Zip Code | 92410 |
Please comment or provide details below to improve the information on KELLY CANADY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.