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Organization
GOOD SHEPHERD COUNSELING CLINIC
Active
Organization
GOOD SHEPHERD COUNSELING CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN MARIE KELL PSYD, MFT (OWNER)
(714) 402-0131
Entity
Organization
Contact information
Practice address
17461 IRVINE BLVD, SUITE D, TUSTIN, CA 92780-3034
(714) 402-0131
Mailing address
30713 RIVERSIDE DR, SUITE 203, LAKE ELSINORE, CA 92530-4714
(951) 678-1642
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MFC39965
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ55205Y
BLUESHIELD
CA
Enumeration date
06/24/2010
Last updated
06/24/2010
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