Active NPI
Kelly Soo, MA, BCBA
- Behavior Analyst
- Culver City, CA
National Provider Identifier
1972914315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-118791
- Practice address
- 6101 W Centinela Ave Ste 380
Culver City, CA 90230-6367 - Phone
- (310) 945-8001
- NPI assigned
- May 19, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-118791 | Primary |
Addresses
Primary practice location
6101 W Centinela Ave Ste 380
Culver City, CA 90230-6367
Mailing address
6101 W Centinela Ave Ste 380
Culver City, CA 90230-6367
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Star of California | Behavior Analyst | Past | Accepting new patients |
| Era Psychological Services, Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Clinical Psychologist
- Ventura, CA
- NPI 1245873769
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400457600000",
"number": "1972914315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6101 W CENTINELA AVE STE 380",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902306367"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6101 W CENTINELA AVE STE 380",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902306367",
"telephone_number": "310-945-8001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOO",
"first_name": "KELLY",
"credential": "MA, BCBA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-05-19",
"last_updated": "2014-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": "1-118791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Culver City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.