Individual
BRETT KELEHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
620 N AURORA ST STE 1, STOCKTON, CA 95202-2276
(209) 468-3720
Mailing address
620 N AURORA ST STE 1, STOCKTON, CA 95202-2276
(209) 468-3720
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000000
—
CA
Enumeration date
10/02/2019
Last updated
10/02/2019
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