Individual ProviderKelly MouaCounselorBehavioral Health & Social Service ProvidersPractice Address1414 N California St, Stockton, CA 95202-1515(209) 468-2385PECOS EnrollmentBased on the most recent information from CMS, provider Kelly Moua does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1740648625Provider TypeIndividualFull NameMoua, KellyGenderFemaleSole ProprietorYesEnumeration Date2/5/2016Last Updated2/5/2016Contact InformationPractice LocationPractice Address1414 N California St, Stockton, CA 95202-1515Phone(209) 468-2385FaxUnlisted FaxMailing LocationMailing Address1414 N California St, Stockton, CA 95202-1515Phone(209) 468-2385FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer