Healthcare Provider Details

I. General information

NPI: 1689073850
Provider Name (Legal Business Name): KELLYE VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 01/28/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 W FIR AVE
FRESNO CA
93711-0618
US

IV. Provider business mailing address

3715 W FIR AVE
FRESNO CA
93711-0618
US

V. Phone/Fax

Practice location:
  • Phone: 559-824-5921
  • Fax:
Mailing address:
  • Phone: 559-824-5921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number107805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: