Keenan Ellis

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

Y4620530 Issued in CA

Practice address

1947 Galileo CT Ste 101
Davis, CA 95618-4882

Phone

(153) 022-0145

NPI assigned

Jul 29, 2022

Last updated

Sep 26, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1659052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1518693761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2707 BRANDYWINE PL",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956162904",
            "telephone_number": "802-999-1442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1947 GALILEO CT STE 101",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956184882",
            "telephone_number": "153-022-0145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "KEENAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-29",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "Y4620530",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": "Y4620530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Elder
• Lisa Ann Elenberger, DDS
• Elisa E Horta, MD,MPH, a Professional Medical Corporation
• Thomas E Elliott, M.D.
• Ashli Ellis, PSY.D.
• Florence Elmore, PSY.D.
• Emerie G Elrod I
• Samuel Turner Elson, AMFT
• Emerge Center for Social and Emotional Learning
• David Emojong

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.