Provider Demographics
NPI:1821538869
Name:HYATT, KELLY MICHELE
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MICHELE
Last Name:HYATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MICHELE
Other - Last Name:FRALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:111 E ARRELLAGA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1903
Mailing Address - Country:US
Mailing Address - Phone:805-882-2424
Mailing Address - Fax:805-882-2422
Practice Address - Street 1:111 E ARRELLAGA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-1903
Practice Address - Country:US
Practice Address - Phone:805-882-2424
Practice Address - Fax:805-882-2422
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT97295106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist