Provider Demographics
NPI:1821222159
Name:KELLEY, EILEEN (MFT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1767 MARKET ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1940
Mailing Address - Country:US
Mailing Address - Phone:530-209-2847
Mailing Address - Fax:
Practice Address - Street 1:1767 MARKET ST
Practice Address - Street 2:SUITE A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1940
Practice Address - Country:US
Practice Address - Phone:530-209-2847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health