Provider Demographics
NPI:1760512180
Name:GRAHAM FLORES, KELLY A (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:GRAHAM FLORES
Suffix:
Gender:F
Credentials:MA, 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 2091
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92018-2091
Mailing Address - Country:US
Mailing Address - Phone:661-406-3556
Mailing Address - Fax:
Practice Address - Street 1:3038 GREENWICH ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-7029
Practice Address - Country:US
Practice Address - Phone:661-406-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47629106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist