Provider Demographics
NPI:1306104757
Name:ORCHARD, KELLY (LMFT77525)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ORCHARD
Suffix:
Gender:F
Credentials:LMFT77525
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32605 TEMECULA PKWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6837
Mailing Address - Country:US
Mailing Address - Phone:951-970-6254
Mailing Address - Fax:951-710-8680
Practice Address - Street 1:32605 TEMECULA PKWY
Practice Address - Street 2:SUITE 207
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6837
Practice Address - Country:US
Practice Address - Phone:951-970-6254
Practice Address - Fax:951-710-8680
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT77525106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist