Provider Demographics
NPI:1780491662
Name:MCCAMEY, KELLI SHANNON (APCC)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:SHANNON
Last Name:MCCAMEY
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 E NUBIA ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-2020
Mailing Address - Country:US
Mailing Address - Phone:626-646-4877
Mailing Address - Fax:
Practice Address - Street 1:427 S MARENGO AVE STE 5
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3134
Practice Address - Country:US
Practice Address - Phone:213-718-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-14
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health