Provider Demographics
NPI:1578909586
Name:MUNOZ-KELLY, ANAIS (PSYD, MFT)
Entity Type:Individual
Prefix:DR
First Name:ANAIS
Middle Name:
Last Name:MUNOZ-KELLY
Suffix:
Gender:F
Credentials:PSYD, MFT
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 11414
Mailing Address - Street 2:MARINA DEL REY
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-0414
Mailing Address - Country:US
Mailing Address - Phone:310-482-1262
Mailing Address - Fax:
Practice Address - Street 1:4640 ADMIRALTY WAY STE 318
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6637
Practice Address - Country:US
Practice Address - Phone:310-482-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44559106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist