Healthcare Provider Details

I. General information

NPI: 1386453728
Provider Name (Legal Business Name): KELCIE RAECYNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1172 E GRAND AVE
ARROYO GRANDE CA
93420-2556
US

IV. Provider business mailing address

1559 SEABRIGHT AVE
GROVER BEACH CA
93433-2522
US

V. Phone/Fax

Practice location:
  • Phone: 805-801-2231
  • Fax:
Mailing address:
  • Phone: 805-315-1193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: