Provider Demographics
NPI:1831312032
Name:MCSWAN, KELLI LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:LYNN
Last Name:MCSWAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 PACIFIC COAST HWY
Mailing Address - Street 2:#171
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6214
Mailing Address - Country:US
Mailing Address - Phone:909-851-0512
Mailing Address - Fax:
Practice Address - Street 1:701 SANTA MONICA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2625
Practice Address - Country:US
Practice Address - Phone:310-993-4103
Practice Address - Fax:805-494-8385
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18574103G00000X, 103TH0100X, 103TR0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation