Provider Demographics
NPI:1124109905
Name:VALES, KELLY ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:VALES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 EL CAJON BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1293
Mailing Address - Country:US
Mailing Address - Phone:619-303-8545
Mailing Address - Fax:
Practice Address - Street 1:4275 EL CAJON BLVD
Practice Address - Street 2:101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1293
Practice Address - Country:US
Practice Address - Phone:619-283-9624
Practice Address - Fax:619-641-7656
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS170721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical