Provider Demographics
NPI:1538568134
Name:RULE, KELLI ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:ANN
Last Name:RULE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 COCHRAN ST # 240
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2780
Mailing Address - Country:US
Mailing Address - Phone:805-624-2121
Mailing Address - Fax:
Practice Address - Street 1:176 HOLSTON DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4531
Practice Address - Country:US
Practice Address - Phone:213-247-0594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30541103TC0700X
CA30541103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist