MEDICARE: KELLEY GOO

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	101YS0200X	School Counselor

General Provider Information

NPI Number	:	1912878836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY GOO

Provider Business Mailing Address
First Line	:	2600 RIPLEY AVE
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-4555
Country	:	US
Telephone Number	:	310-379-5449
Fax Number	:	310-798-8610

Provider Business Practice Location Address
First Line	:	2600 RIPLEY AVE
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-4555
Country	:	US
Telephone Number	:	310-379-5449
Fax Number	:	310-798-8610

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

Provider Enumeration Date	:	09/15/2025
Last Update Date	:	09/15/2025

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Directions to “ KELLEY GOO ” Practice Location

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