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General NPI Number Information
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NPI Number | 1669564555
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Entity Type | Individual
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Provider Name | KELLY JEANNE HIGDON
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Gender | Female
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 05/05/2010
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Provider Practice Location Address
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Address Line | 22362 GILBERTO STE 205
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-2153
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Country | US
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Telephone | 714-682-6417
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Fax |
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Provider Business Mailing Address
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Address Line | 2035 E BALL RD STE 200
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City | ANAHEIM
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State | CA
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Zip | 92806-5157
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC45351
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License Number State | CA
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