Provider Demographics
NPI:1790978450
Name:DEE ANN MARX-KELLY
Entity Type:Organization
Organization Name:DEE ANN MARX-KELLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MARX-KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:408-246-3525
Mailing Address - Street 1:1032 W HEDDING ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1217
Mailing Address - Country:US
Mailing Address - Phone:408-246-3525
Mailing Address - Fax:408-246-1050
Practice Address - Street 1:1032 W HEDDING ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1217
Practice Address - Country:US
Practice Address - Phone:408-246-3525
Practice Address - Fax:408-246-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT30728106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386787968OtherNPI 1