Provider Demographics
NPI:1851374235
Name:KELLIHER, RICHARD J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:KELLIHER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 W MISSION ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2450
Mailing Address - Country:US
Mailing Address - Phone:805-687-8021
Mailing Address - Fax:805-687-8021
Practice Address - Street 1:22 W MISSION ST
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2450
Practice Address - Country:US
Practice Address - Phone:805-687-8021
Practice Address - Fax:805-687-8021
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11772103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY117720Medicaid
CAPSY117720Medicaid