| Doctor Name: | GARY KELLEY |
| NPI Number: | 1215340856 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | PSY 17857 |
| Business Practice Address: | 4001 King Ave Corcoran, CA - 932129611 |
| Business Phone Number: | 5599928800 |
| Business Fax Number: | |
| Mailing Address: | 4001 King Ave, CORCORAN |
| State: | CA |
| Postal Code: | 932129611 |
| Phone Number: | 5599928800 |
| Fax Number: | |
| NPI Enumeration Date: | 06/10/2014 |
| NPI Last Update Date: | 06/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY 17857 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |