Individual
MISS KELLY MARIE GRANGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
222 W MAIN ST STE 101, TUSTIN, CA 92780
(949) 381-1519
Mailing address
222 W MAIN ST STE 101, TUSTIN, CA 92780-7711
(949) 381-1519
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY28523
CA
Other
Enumeration date
07/15/2008
Last updated
05/29/2018
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