Provider Demographics
NPI:1285063792
Name:MUHONEN, KELLY (MS,)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MUHONEN
Suffix:
Gender:F
Credentials:MS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E WALNUT ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1452
Mailing Address - Country:US
Mailing Address - Phone:626-590-2461
Mailing Address - Fax:
Practice Address - Street 1:1000 E WALNUT ST
Practice Address - Street 2:SUITE 211
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1452
Practice Address - Country:US
Practice Address - Phone:626-590-2461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52613106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist