Provider Demographics
NPI:1912878836
Name:GOO, KELLEY
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:GOO
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 1:2600 RIPLEY AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4555
Mailing Address - Country:US
Mailing Address - Phone:310-379-5449
Mailing Address - Fax:310-798-8610
Practice Address - Street 1:2600 RIPLEY AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4555
Practice Address - Country:US
Practice Address - Phone:310-379-5449
Practice Address - Fax:310-798-8610
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool