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NPI Code Detail

MEDICARE: MADELEINE KELLY LMFT

MEDICARE: MADELEINE KELLY LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor107640CO
2106H00000XMarriage & Family Therapist107640CA

General Provider Information

NPI Number : 1285209569
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELEINE KELLY LMFT
Provider Business Mailing Address
First Line : 1942 DEERPARK DR APT 137
Second Line :
City : FULLERTON
State : CA
Zip : 92831-1534
Country : US
Telephone Number : 714-397-4502
Fax Number :
Provider Business Practice Location Address
First Line : 5199 E PACIFIC COAST HWY STE 330N
Second Line :
City : LONG BEACH
State : CA
Zip : 90804-3353
Country : US
Telephone Number : 562-365-2020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2021
Last Update Date : 09/21/2021

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Directions to “ MADELEINE KELLY LMFT” Practice Location

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