Provider Demographics
NPI:1710183892
Name:KELLY, JAMES AUSTIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:AUSTIN
Last Name:KELLY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4713 1ST ST
Mailing Address - Street 2:SUITE 242
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7361
Mailing Address - Country:US
Mailing Address - Phone:925-337-5919
Mailing Address - Fax:
Practice Address - Street 1:4328 CIRCLE AVE
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4648
Practice Address - Country:US
Practice Address - Phone:925-337-5919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health