Healthcare Provider Details

I. General information

NPI: 1699848614
Provider Name (Legal Business Name): KELLI MARGARET MCDOUGALL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 NATIVIDAD RD
SALINAS CA
93906-3144
US

IV. Provider business mailing address

8774 TOYON CT
GILROY CA
95020-7406
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4510
  • Fax:
Mailing address:
  • Phone: 831-206-2016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY22727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: