Healthcare Provider Details

I. General information

NPI: 1194323402
Provider Name (Legal Business Name): KELLETT TIGHE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

482 S EL MOLINO AVE
PASADENA CA
91101-3451
US

IV. Provider business mailing address

482 S EL MOLINO AVE
PASADENA CA
91101-3451
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-6999
  • Fax: 626-449-6999
Mailing address:
  • Phone: 626-449-6999
  • Fax: 626-449-6999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number135129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: