Provider Demographics
NPI:1326373622
Name:KEELY, PATRICIA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:KEELY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 CAPISTRANO AVE
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-7201
Mailing Address - Country:US
Mailing Address - Phone:805-438-4238
Mailing Address - Fax:
Practice Address - Street 1:15500 CHISPA RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-6519
Practice Address - Country:US
Practice Address - Phone:805-471-7790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 35568101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA402137OtherMENTAL HEALTH NETWORK