MEDICARE: KELLIE LOCKWOOD-RIOS, INDIVIDUAL AND FAMILY THERAPY

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1639941396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELLIE LOCKWOOD-RIOS, INDIVIDUAL AND FAMILY THERAPY

Provider Business Mailing Address
First Line	:	4433 E VILLAGE RD STE I
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1505
Country	:	US
Telephone Number	:	562-528-6043
Fax Number	:	562-317-8121

Provider Business Practice Location Address
First Line	:	4433 E VILLAGE RD STE I
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1505
Country	:	US
Telephone Number	:	562-528-6043
Fax Number	:	562-317-8121

Authorized Official
Title or Position	:	OWNER
Name	:	KELLIE SUNSHINE LOCKWOOD-RIOS
Credential	:	LMFT
Telephone Number	:	562-528-6043

Provider Enumeration Date	:	10/26/2023
Last Update Date	:	03/14/2026

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