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NPI Code Detail

MEDICARE: GEORGIE A KELLY MA, LPCC

MEDICARE: GEORGIE A KELLY MA, LPCC
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
1101YM0800XMental Health Counselor9136CA

General Provider Information

NPI Number : 1376029983
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGIE A KELLY MA, LPCC
Provider Business Mailing Address
First Line : 11858 BERNARDO PLAZA CT STE 210
Second Line :
City : SAN DIEGO
State : CA
Zip : 92128-2411
Country : US
Telephone Number : 858-304-0928
Fax Number : 858-592-1495
Provider Business Practice Location Address
First Line : 11858 BERNARDO PLAZA CT STE 210
Second Line :
City : SAN DIEGO
State : CA
Zip : 92128-2411
Country : US
Telephone Number : 858-304-0928
Fax Number : 858-592-1495
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2018
Last Update Date : 01/25/2022

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Directions to “ GEORGIE A KELLY MA, LPCC” Practice Location

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