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General NPI Number Information
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NPI Number | 1831312032
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Entity Type | Individual
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Provider Name | KELLI LYNN MCSWAN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 701 SANTA MONICA BLVD STE 230
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City | SANTA MONICA
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State | CA
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Zip | 90401-2625
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Country | US
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Telephone | 310-993-4103
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Fax | 805-494-8385
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Provider Business Mailing Address
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Address Line | 1077 PACIFIC COAST HWY #171
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City | SEAL BEACH
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State | CA
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Zip | 90740-6214
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Country | US
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Telephone | 909-851-0512
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PSY 18574
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | PSY 18574
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | PSY 18574
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 18574
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License Number State | CA
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