Provider Demographics
NPI:1285983627
Name:LLEWELLYN, KELLI CHRISTINE (LMFT)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:CHRISTINE
Last Name:LLEWELLYN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 S BREA BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5312
Mailing Address - Country:US
Mailing Address - Phone:714-529-9274
Mailing Address - Fax:714-529-9276
Practice Address - Street 1:770 S BREA BLVD STE 213
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5312
Practice Address - Country:US
Practice Address - Phone:714-529-9274
Practice Address - Fax:714-529-9276
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 36051106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist