Provider Demographics
NPI:1902645567
Name:BRITTON, KELLY (PPS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BRITTON
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1336
Mailing Address - Country:US
Mailing Address - Phone:510-558-3750
Mailing Address - Fax:
Practice Address - Street 1:1259 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1336
Practice Address - Country:US
Practice Address - Phone:510-558-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool