Doctor Name: | MISS KELLY MARIE GRANGER |
NPI Number: | 1164686515 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. |
License Number: | |
Business Practice Address: | 11721 Telegraph Rd Ste A Santa Fe Springs, CA - 906706835 |
Business Phone Number: | 5629498455 |
Business Fax Number: | |
Mailing Address: | 1083 Ohio Ave Apt C, LONG BEACH |
State: | CA |
Postal Code: | 908043697 |
Phone Number: | 5624383720 |
Fax Number: | |
NPI Enumeration Date: | 07/15/2008 |
NPI Last Update Date: | 07/28/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |