Provider Demographics
NPI:1386302149
Name:HYLAND, KEELYANNE KERNAN (LCSW)
Entity type:Individual
Prefix:
First Name:KEELYANNE
Middle Name:KERNAN
Last Name:HYLAND
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 1:11234 VALLEY BLVD STE 13
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-3241
Mailing Address - Country:US
Mailing Address - Phone:323-917-2357
Mailing Address - Fax:
Practice Address - Street 1:11234 VALLEY BLVD STE 13
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3241
Practice Address - Country:US
Practice Address - Phone:323-917-2357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1243051041C0700X
CA105707101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical