Provider Demographics
NPI:1821635061
Name:KELLY, NINA B (LMFT)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:B
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 OAK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1335
Mailing Address - Country:US
Mailing Address - Phone:415-846-8236
Mailing Address - Fax:
Practice Address - Street 1:555 SOQUEL AVE STE 260
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2340
Practice Address - Country:US
Practice Address - Phone:415-846-8236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health