Kelli Rose Ezell, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

119424 Issued in CA

Practice address

8210 Constantine Dr Apt 25
Huntington Beach, CA 92646-1787

Phone

(714) 401-1796

NPI assigned

Jan 8, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Telecare Corporation

  • Mental Illness Community Based Residential Treatment Facility
  • San Diego, CA
  • NPI 1275398935
  NPD (past)
• Telecare Corporation

  • Psychiatric Residential Treatment Facility
  • Anaheim, CA
  • NPI 1902312564
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1124616792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8210 CONSTANTINE DR APT 25",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926461787",
            "telephone_number": "714-401-1796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8210 CONSTANTINE DR APT 25",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926461787",
            "telephone_number": "714-401-1796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZELL",
        "first_name": "KELLI",
        "middle_name": "ROSE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-08",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "119424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Excellent Community Healthcare Center
• Leslie Exconde, REGISTERED NURSE
• Eyecare Specialists Medical Group, Inc
• Eyecare Specialists Medical Group, Inc.
• Eyegen Vision Center Optometry, Inc
• F & N Pharma Inc
• F & N Pharma Inc
• Antoine K Fahd, M.D.
• Fred Fahimy, D.D.S.
• Kylie Faildo, DPT

• Clinical Social Worker in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.