Kelsie Brooke Canole

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

R1453601221 Issued in CA

Practice address

13682 Yorba St
Tustin, CA 92780-1831

Phone

(714) 730-5399

NPI assigned

Aug 22, 2022

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.

• Recovery Homes of America Inc

  • Substance Abuse Rehabilitation Facility
  • Tustin, CA
  • NPI 1962549295
  NPD (past)

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

{
    "created_epoch": "1661126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661126400000",
    "number": "1407574734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13682 YORBA ST",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927801831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13682 YORBA ST",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927801831",
            "telephone_number": "714-730-5399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANOLE",
        "first_name": "KELSIE",
        "middle_name": "BROOKE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-22",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": "R1453601221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ana Belen Campos
• Franki Michelle Campos
• Can Emergency Physicians Medical Group Inc
• Sergio Alejandro Candelas Martinez, DC
• Artemio Cano Jr., R.N.
• Daniel Gia-Nang Cao, D.D.S.
• Richard Cao
• Christopher Caovan, NP-C
• Arione D Capolupo, MFT
• Care Charlize

• Behavior Technician in Tustin, CA
• Providers in Tustin, CA by specialty
• Behavior Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; 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.