Provider Demographics
NPI:1699844670
Name:KELLEY, PATSY ANN (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:PATSY
Middle Name:ANN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-9617
Mailing Address - Country:US
Mailing Address - Phone:530-570-8222
Mailing Address - Fax:
Practice Address - Street 1:1151 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-9617
Practice Address - Country:US
Practice Address - Phone:530-570-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40697106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26-4475452OtherEIN