Healthcare Provider Details

I. General information

NPI: 1124263462
Provider Name (Legal Business Name): KELLEY JOAN HERRIN M. S., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9019 SOQUEL DR # 2F
APTOS CA
95003-4059
US

IV. Provider business mailing address

9019 SOQUEL DR # 2F
APTOS CA
95003-4059
US

V. Phone/Fax

Practice location:
  • Phone: 209-743-9292
  • Fax: 209-532-6767
Mailing address:
  • Phone: 209-743-9292
  • Fax: 209-532-6767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberMFC 46046
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC46046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: