MEDICARE: KELLY ANN HAVLIN M.A

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	104473	CA
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1629400627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ANN HAVLIN M.A

Provider Business Mailing Address
First Line	:	776 E GREEN ST STE 205
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-5405
Country	:	US
Telephone Number	:	626-765-7506
Fax Number	:

Provider Business Practice Location Address
First Line	:	776 E GREEN ST STE 205
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-5405
Country	:	US
Telephone Number	:	626-765-7506
Fax Number	:

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

Provider Enumeration Date	:	08/01/2013
Last Update Date	:	03/06/2026

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Directions to “ KELLY ANN HAVLIN M.A” Practice Location

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