Healthcare Provider Details

I. General information

NPI: 1902273618
Provider Name (Legal Business Name): KELLI SHIFLET LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 SEA LION CT
OCEANSIDE CA
92058-1026
US

IV. Provider business mailing address

914 SEA LION CT
OCEANSIDE CA
92058-1026
US

V. Phone/Fax

Practice location:
  • Phone: 910-280-7997
  • Fax:
Mailing address:
  • Phone: 910-280-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: