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1053060202
KELLY KEOMUANGCHANH
CERES, CA
NPI
1053060202
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2022-03-23
Last Update Date
2024-12-10
Business Address
KELLY KEOMUANGCHANH
1768 MITCHELL RD STE 301
CERES, CA 95307-2156
Phone number: 209-353-4838
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Mailing Address
KELLY KEOMUANGCHANH
1768 MITCHELL RD STE 301
CERES, CA 95307-2156
Phone number: 209-353-4838
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