Provider Demographics
NPI:1790162139
Name:SARAH KELLEY, M.S., LMFT
Entity Type:Organization
Organization Name:SARAH KELLEY, M.S., LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:714-271-3643
Mailing Address - Street 1:604 S PORTO PL
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-1438
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2030 E 4TH ST
Practice Address - Street 2:STE. 158
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3940
Practice Address - Country:US
Practice Address - Phone:714-271-3643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT83792251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health