Healthcare Provider Details

I. General information

NPI: 1497689871
Provider Name (Legal Business Name): KELLY LEAHY MCKEOWN M.A., LMFT, PPSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 CLOVERDALE LN
CAMPBELL CA
95008-1702
US

IV. Provider business mailing address

412 CLOVERDALE LN
CAMPBELL CA
95008-1702
US

V. Phone/Fax

Practice location:
  • Phone: 408-674-4565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT41029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: