Provider Demographics
NPI:1023517273
Name:LITTLE, KELLY (LMFT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LITTLE
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 392
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91017-0392
Mailing Address - Country:US
Mailing Address - Phone:626-603-8396
Mailing Address - Fax:626-413-3423
Practice Address - Street 1:100 W FOOTHILL BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1170
Practice Address - Country:US
Practice Address - Phone:626-603-8396
Practice Address - Fax:626-413-3423
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101665106H00000X
CA123673106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist