Provider Demographics
NPI:1285209569
Name:KELLY, MADELEINE (LMFT)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MADELEINE
Other - Middle Name:
Other - Last Name:FRANCUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1942 DEERPARK DR APT 137
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1534
Mailing Address - Country:US
Mailing Address - Phone:714-397-4502
Mailing Address - Fax:
Practice Address - Street 1:5199 E PACIFIC COAST HWY STE 330N
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3353
Practice Address - Country:US
Practice Address - Phone:562-365-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO107640101YM0800X
CA107640106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health