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Individual
MERANDA L JELLY
Active
Individual
MERANDA L JELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RADT-I
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
R1439940721
CA
374700000X
Technician
R1439940721
CA
Other
Enumeration date
07/27/2021
Last updated
07/27/2021
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