Provider Demographics
NPI:1639941396
Name:KELLIE LOCKWOOD-RIOS, INDIVIDUAL AND FAMILY THERAPY
Entity Type:Organization
Organization Name:KELLIE LOCKWOOD-RIOS, INDIVIDUAL AND FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:SUNSHINE
Authorized Official - Last Name:LOCKWOOD-RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:562-528-6043
Mailing Address - Street 1:4433 E VILLAGE RD STE I
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1505
Mailing Address - Country:US
Mailing Address - Phone:562-528-6043
Mailing Address - Fax:562-317-8121
Practice Address - Street 1:4433 E VILLAGE RD STE I
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1505
Practice Address - Country:US
Practice Address - Phone:562-528-6043
Practice Address - Fax:562-317-8121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health