Provider Demographics
NPI:1831363811
Name:KELLY, LORETTA
Entity type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:
Last Name: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 1:4805 MARIGOLD AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35207-1223
Mailing Address - Country:US
Mailing Address - Phone:310-989-2545
Mailing Address - Fax:
Practice Address - Street 1:3605 LONG BEACH BLVD
Practice Address - Street 2:110
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4013
Practice Address - Country:US
Practice Address - Phone:562-427-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-21
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist