Healthcare Provider Details

I. General information

NPI: 1033023643
Provider Name (Legal Business Name): CHANPIROUM KELLEY APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE KELLEY

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W MERCED AVE
WEST COVINA CA
91790-3406
US

IV. Provider business mailing address

1717 W MERCED AVE
WEST COVINA CA
91790-3406
US

V. Phone/Fax

Practice location:
  • Phone: 626-931-1810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC22278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: