Provider Demographics
NPI:1053847111
Name:KELLAS CLINE, KYLIE (LMFT)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:KELLAS CLINE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:JEAN
Other - Last Name:KELLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFT
Mailing Address - Street 1:17752 SKY PARK CIR STE 210
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-4469
Mailing Address - Country:US
Mailing Address - Phone:714-584-9018
Mailing Address - Fax:
Practice Address - Street 1:17752 SKY PARK CIR STE 210
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4469
Practice Address - Country:US
Practice Address - Phone:714-584-9018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120845101YM0800X
106H00000X
CA92818106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health