Healthcare Provider Details

I. General information

NPI: 1467003624
Provider Name (Legal Business Name): MS. KELLY KAPIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39155 LIBERTY ST STE A110 PO BOX 5006
FREMONT CA
94537
US

IV. Provider business mailing address

246 SCOTT ST
LIVERMORE CA
94551-4928
US

V. Phone/Fax

Practice location:
  • Phone: 510-574-2000
  • Fax: 510-574-2001
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number154678
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: