MEDICARE: KELLI REA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	160677	CA

General Provider Information

NPI Number	:	1134085012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI REA

Provider Business Mailing Address
First Line	:	1201 N. CATALINA AVE.
Second Line	:	PO BOX 3062
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277
Country	:	US
Telephone Number	:	310-961-1608
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 S PACIFIC COAST HWY STE B
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5612
Country	:	US
Telephone Number	:	310-961-1608
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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Directions to “ KELLI REA ” Practice Location

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