Most Relevant Information
Provider Data
| NPI Number: | 1003570136 |
| Provider Name: | KEELYN M CLEMENCE |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/25/2021 |
| Last Updated: | 10/25/2021 |
Provider Practice Location
1405 MANCHESTER WAY
TUSTIN
CA
927821785
Practice Location Phone/Fax
| Phone: | 7148562696 |
| Fax: |
Provider Mailing Location
1405 MANCHESTER WAY
TUSTIN
CA
927821785
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |