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NPI Code Detail

MEDICARE: KRISTEN KELLEHER

MEDICARE: KRISTEN KELLEHER
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1700924818
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN KELLEHER
Provider Business Mailing Address
First Line : 6863 CAMINITO MUNDO UNIT 15
Second Line :
City : SAN DIEGO
State : CA
Zip : 92119-2361
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 17701 SAN PASQUAL VALLEY RD
Second Line :
City : ESCONDIDO
State : CA
Zip : 92025-5301
Country : US
Telephone Number : 760-741-4300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2007
Last Update Date : 07/08/2007

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Directions to “ KRISTEN KELLEHER ” Practice Location

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