Provider Demographics
NPI:1093847337
Name:LEWIS, KELLEY JOYCE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:JOYCE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3228
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-1428
Mailing Address - Country:US
Mailing Address - Phone:323-495-6521
Mailing Address - Fax:866-219-1310
Practice Address - Street 1:16300 CRENSHAW BLVD STE 208C
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-1441
Practice Address - Country:US
Practice Address - Phone:818-751-2008
Practice Address - Fax:866-219-1310
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT50297101YM0800X
CALMFT50297106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health