Provider Demographics
NPI:1750770632
Name:JUSE-KELLY, FELICIA
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:JUSE-KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 GILBRETH RD
Mailing Address - Street 2:SUITE #230
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1225
Mailing Address - Country:US
Mailing Address - Phone:650-348-6603
Mailing Address - Fax:650-342-0554
Practice Address - Street 1:1818 GILBRETH RD
Practice Address - Street 2:SUITE #230
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1225
Practice Address - Country:US
Practice Address - Phone:650-348-6603
Practice Address - Fax:650-342-0554
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)