MEDICARE: MISS KELLY ANN CHINARIAN M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC49895	CA

General Provider Information

NPI Number	:	1063555209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KELLY ANN CHINARIAN M.S.

Provider Business Mailing Address
First Line	:	16415 COLORADO AVE STE 305
Second Line	:
City	:	PARAMOUNT
State	:	CA
Zip	:	90723-5053
Country	:	US
Telephone Number	:	562-445-8177
Fax Number	:

Provider Business Practice Location Address
First Line	:	16415 COLORADO AVE STE 305
Second Line	:
City	:	PARAMOUNT
State	:	CA
Zip	:	90723-5053
Country	:	US
Telephone Number	:	562-445-8177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	11/17/2014

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