Demetri Rashad Kelley

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

11519 Carlisle PL
Rancho Cucamonga, CA 91730-7233

Phone

(909) 484-7259

NPI assigned

Aug 10, 2022

Sex

Male

Sole proprietor

Yes

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

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.

• Tender Loving Care Home for Boys, Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Rancho Cucamonga, CA
  • NPI 1356972772
  NPD (past)
• Tender Loving Care Home for Boys, Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Rancho Cucamonga, CA
  • NPI 1720514896
  NPD (past)

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

{
    "created_epoch": "1660089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1659009389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16258 LADYBIRD WAY",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923365828",
            "telephone_number": "760-605-4778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11519 CARLISLE PL",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917307233",
            "telephone_number": "909-484-7259"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7839 Patriot Pl",
            "address_purpose": "LOCATION",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "postal_code": "917302640",
            "country_code": "US",
            "telephone_number": "909-948-2898",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "DEMETRI",
        "middle_name": "RASHAD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-10",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsie Keating, LCSW
• Kayla Keeling, RBT
• Blake Clete Keen, DDS
• Rachel Joy Keener
• John Kelleher
• Afton Valley Kelly
• Ian Kelly
• Aishah Kelsick-Ricks
• Carla Ann Kendig, AMFT
• Peter Kennedy Jr., LCSW

• Counselor in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 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.