Provider Demographics
NPI:1386453728
Name:RAECYNA, KELCIE
Entity type:Individual
Prefix:
First Name:KELCIE
Middle Name:
Last Name:RAECYNA
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 1:1559 SEABRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2522
Mailing Address - Country:US
Mailing Address - Phone:805-315-1193
Mailing Address - Fax:
Practice Address - Street 1:1172 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2556
Practice Address - Country:US
Practice Address - Phone:805-801-2231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist