Healthcare Provider Details

I. General information

NPI: 1780595876
Provider Name (Legal Business Name): KELSEY LEMMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 NEW YORK AVE
LA CRESCENTA CA
91214-2567
US

IV. Provider business mailing address

6652 CLEON AVE
NORTH HOLLYWOOD CA
91606-2102
US

V. Phone/Fax

Practice location:
  • Phone: 818-249-1863
  • Fax:
Mailing address:
  • Phone: 574-304-6855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220127714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: