Provider Demographics
NPI:1871976225
Name:CHANG, KELLIE LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:LYNN
Last Name:CHANG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:LYNN
Other - Last Name:CASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5837 DEL TRIGO LN
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:CA
Mailing Address - Zip Code:94517-1367
Mailing Address - Country:US
Mailing Address - Phone:925-451-4022
Mailing Address - Fax:
Practice Address - Street 1:5837 DEL TRIGO LN
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:CA
Practice Address - Zip Code:94517-1367
Practice Address - Country:US
Practice Address - Phone:925-451-4022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker