Healthcare Provider Details

I. General information

NPI: 1821946880
Provider Name (Legal Business Name): KELSEY LULLO M.A., APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5475 E. LA PALMA AVE. SUITE 200
ANAHEIM HILLS CA
92807
US

IV. Provider business mailing address

PO BOX 7182
NEWPORT BEACH CA
92658-7182
US

V. Phone/Fax

Practice location:
  • Phone: 714-485-0354
  • Fax: 714-485-2111
Mailing address:
  • Phone: 949-722-7118
  • Fax: 949-579-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: