Individual
DR. HEATHER LAKE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
800 BETHANY DR, SCOTTS VALLEY, CA 95066-2820
(831) 438-3800
Mailing address
270 GASTON CIR, SCOTTS VALLEY, CA 95066-2823
(831) 247-1490
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY 18917
CA
Other
Enumeration date
02/20/2007
Last updated
07/08/2007
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