Provider Demographics
NPI:1083923296
Name:CHANG, KELLY (MS)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-6713
Mailing Address - Country:US
Mailing Address - Phone:562-484-3385
Mailing Address - Fax:562-484-0269
Practice Address - Street 1:9901 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6713
Practice Address - Country:US
Practice Address - Phone:562-484-3385
Practice Address - Fax:562-484-0269
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA87208106H00000X, 390200000X
CA105742106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program