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General NPI Number Information
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NPI Number | 1437963485
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Entity Type | Organization
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Legal Business Name | KAELYN MARIE LICENSED PROFESSIONAL CLINICAL COUNSELOR INC
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Dates
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Enumeration Date | 02/01/2025
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 3033 FIFTH AVE STE 230
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City | SAN DIEGO
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State | CA
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Zip | 92103-5873
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Country | US
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Telephone | 323-628-8452
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Fax |
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Provider Business Mailing Address
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Address Line | 3033 FIFTH AVE STE 230
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City | SAN DIEGO
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State | CA
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Zip | 92103-5873
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Country | US
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Telephone | 509-951-2783
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KAELYN KENNEDY
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Credential | LPCC
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Telephone | 509-951-2783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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