Provider Demographics
NPI:1063926004
Name:SHELINE-ARELLANO, KELLY SUZANNE
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:SUZANNE
Last Name:SHELINE-ARELLANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92564-0176
Mailing Address - Country:US
Mailing Address - Phone:951-852-6200
Mailing Address - Fax:
Practice Address - Street 1:39509 CEDARWOOD DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-5305
Practice Address - Country:US
Practice Address - Phone:951-304-1040
Practice Address - Fax:951-304-9767
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT98781106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist