Provider Demographics
NPI:1366240988
Name:TRUJILLO, KELLY DIANE (AMFT, APCC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:DIANE
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15100 BROOKHURST ST APT 505
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-0107
Mailing Address - Country:US
Mailing Address - Phone:949-414-9338
Mailing Address - Fax:
Practice Address - Street 1:15100 BROOKHURST ST APT 505
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-0107
Practice Address - Country:US
Practice Address - Phone:714-376-5438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18655101YP2500X
CA153286106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional