Provider Demographics
NPI:1518384882
Name:PRISBE, KELLI (LCSW)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:PRISBE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MARIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4260
Mailing Address - Country:US
Mailing Address - Phone:805-907-0646
Mailing Address - Fax:
Practice Address - Street 1:501 MARIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4260
Practice Address - Country:US
Practice Address - Phone:805-907-0646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 18985104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker