Kelly Lewallen | Palm Desert, CA • PECOS Search

Kelly Lewallen

Marriage & Family Therapist

Behavioral Health & Social Service Providers

44672 Monterey Ave, Palm Desert, CA 92260-3326

PECOS Enrollment

Based on the most recent information from CMS, provider Kelly Lewallen does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 6 days ago.

Profile Details

Provider ID
1346567773
Provider Type
Individual
Full Name
Lewallen, Kelly
Credential
MFT

Gender
Female
Sole Proprietor
Yes
Enumeration Date
4/25/2010
Last Updated
4/25/2010

Contact Information

Practice Location

44672 Monterey Ave, Palm Desert, CA 92260-3326

Unlisted Fax

Mailing Location

PO Box 6753, La Quinta, CA 92248-6753

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 106H00000X Primary	Description Marriage & Family Therapist Behavioral Health & Social Service Providers	License 37832 California