Provider Demographics
NPI:1073632840
Name:MCCRAY, KELLIE ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:ANN
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6519 8TH AVE # 46
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-4313
Mailing Address - Country:US
Mailing Address - Phone:323-750-5167
Mailing Address - Fax:323-759-2697
Practice Address - Street 1:439 W 97TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-3968
Practice Address - Country:US
Practice Address - Phone:323-754-2856
Practice Address - Fax:323-754-1843
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA178981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical