MEDICARE: KELLY MUHONEN 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	52613	CA

General Provider Information

NPI Number	:	1285063792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY MUHONEN M.S,

Provider Business Mailing Address
First Line	:	1000 E WALNUT ST
Second Line	:	SUITE 211
City	:	PASADENA
State	:	CA
Zip	:	91106-1452
Country	:	US
Telephone Number	:	626-590-2461
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 E WALNUT ST
Second Line	:	SUITE 211
City	:	PASADENA
State	:	CA
Zip	:	91106-1452
Country	:	US
Telephone Number	:	626-590-2461
Fax Number	:

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

Provider Enumeration Date	:	11/05/2013
Last Update Date	:	11/05/2013

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