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General NPI Number Information
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NPI Number | 1780073833
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Entity Type | Individual
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Provider Name | KELISHA LAGRONE
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Gender | Female
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 3478 BUSKIRK AVE STE 260
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City | PLEASANT HILL
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State | CA
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Zip | 94523-4358
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Country | US
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Telephone | 925-360-7860
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Fax |
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Provider Business Mailing Address
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Address Line | 7 W MAGNOLIA ST # 260
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City | STOCKTON
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State | CA
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Zip | 95202-1246
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Country | US
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Telephone | 510-634-8846
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 115287
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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