Individual
BRANDON KOELLISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
20312 RANCHO VILLA RD, RAMONA, CA 92065-7655
(858) 247-1536
Mailing address
20312 RANCHO VILLA RD, RAMONA, CA 92065-7655
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111662
CERTIFIED SEX ADDICTION COUNSELOR
CA
Enumeration date
08/05/2022
Last updated
08/05/2022
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