Individual
ANDY BURL KELLEMS II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC
Contact information
Practice address
3151 AIRWAY AVE STE F107, COSTA MESA, CA 92626-4623
(714) 964-6730
(714) 964-4382
Mailing address
21062 BROOKHURST ST STE 201, HUNTINGTON BEACH, CA 92646-7404
(714) 964-6730
(714) 964-4382
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
081486
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
081486
CAADE
CA
Enumeration date
04/29/2015
Last updated
04/29/2015
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