Provider Demographics
NPI:1073262291
Name:KELLY KARJOO PSYD PSYCHOLOGIST INC
Entity Type:Organization
Organization Name:KELLY KARJOO PSYD PSYCHOLOGIST INC
Other - Org Name:KELLY V KARJOO PSYD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:V
Authorized Official - Last Name:KARJOO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:949-350-5747
Mailing Address - Street 1:25108 MARGUERITE PKWY # A89
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-2497
Mailing Address - Country:US
Mailing Address - Phone:949-350-5747
Mailing Address - Fax:
Practice Address - Street 1:25108 MARGUERITE PKWY # A89
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-2497
Practice Address - Country:US
Practice Address - Phone:949-350-5747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-23
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health