Provider Demographics
NPI:1255599783
Name:KELLY, KAREN E (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:E
Last Name:KELLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9267 GREENBACK LN
Mailing Address - Street 2:SUITE B-98
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-4863
Mailing Address - Country:US
Mailing Address - Phone:916-983-6898
Mailing Address - Fax:
Practice Address - Street 1:9267 GREENBACK LN
Practice Address - Street 2:SUITE B-98
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4863
Practice Address - Country:US
Practice Address - Phone:916-983-6898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9993103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist