Basic Information
| Provider Information | |||||||||
| NPI: | 1376090373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCFARLAND | ||||||||
| FirstName: | KELLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8739 E FAIRVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | SAN GABRIEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917751207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617558823 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1950 SOUTH SUNWEST LANE SUITE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924153840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9092524017 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2016 | ||||||||
| LastUpdateDate: | 06/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 7068 | 05 | CA | MEDICAID | 6758 | 05 | CA | MEDICAID | 7420 | 05 | CA | MEDICAID |