Provider Demographics
NPI:1457572786
Name:KELLY, TOMI YVETTE (LPCC13198)
Entity Type:Individual
Prefix:MS
First Name:TOMI
Middle Name:YVETTE
Last Name:KELLY
Suffix:
Gender:F
Credentials:LPCC13198
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6145 IMPERIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-4213
Mailing Address - Country:US
Mailing Address - Phone:619-528-8994
Mailing Address - Fax:
Practice Address - Street 1:6145 IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-4213
Practice Address - Country:US
Practice Address - Phone:619-262-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC13198101YM0800X
261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone