Healthcare Provider Details

I. General information

NPI: 1679331854
Provider Name (Legal Business Name): KELLI LANE REDFIELD LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E 3RD AVE # 200
ESCONDIDO CA
92025-4201
US

IV. Provider business mailing address

1412 WINDSONG LN
ESCONDIDO CA
92026-7834
US

V. Phone/Fax

Practice location:
  • Phone: 949-630-8776
  • Fax:
Mailing address:
  • Phone: 949-630-8776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: