Provider Demographics
NPI:1316157555
Name:MILES-MARANZ, KELLEE
Entity type:Individual
Prefix:
First Name:KELLEE
Middle Name:
Last Name:MILES-MARANZ
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 1:3130 BALFOUR RD STE D
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5516
Mailing Address - Country:US
Mailing Address - Phone:925-519-3375
Mailing Address - Fax:925-666-4741
Practice Address - Street 1:160 B GUTHRIE LN
Practice Address - Street 2:SUITE 1
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4060
Practice Address - Country:US
Practice Address - Phone:925-519-3375
Practice Address - Fax:925-666-4741
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA46894106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty