Provider Demographics
NPI:1700834850
Name:KELLEHER, JAMES P III (MA, LMHC, LPC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:P
Last Name:KELLEHER
Suffix:III
Gender:M
Credentials:MA, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 E. VIRGINIA AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004
Mailing Address - Country:US
Mailing Address - Phone:602-321-9536
Mailing Address - Fax:
Practice Address - Street 1:99 E. VIRGINIA AVE
Practice Address - Street 2:SUITE #170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004
Practice Address - Country:US
Practice Address - Phone:602-321-9536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2010-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000247101YM0800X
AZLPC-13096101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health