Provider Demographics
NPI:1770880189
Name:WILLIAMS, KELLY ALISHA (PSYD, LMFT)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ALISHA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PSYD, LMFT
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:ALISHA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD, LMFT
Mailing Address - Street 1:1200 WILSHIRE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1931
Mailing Address - Country:US
Mailing Address - Phone:213-481-7464
Mailing Address - Fax:213-481-7147
Practice Address - Street 1:1200 WILSHIRE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017
Practice Address - Country:US
Practice Address - Phone:213-481-7464
Practice Address - Fax:213-481-7147
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT93418106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770880189OtherNATIONAL PROVIDER IDENTIFICATION NUMBER