Healthcare Provider Details

I. General information

NPI: 1285209569
Provider Name (Legal Business Name): MADELEINE KELLY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELEINE FRANCUZ LMFT

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 09/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5199 E PACIFIC COAST HWY STE 330N
LONG BEACH CA
90804-3353
US

IV. Provider business mailing address

1942 DEERPARK DR APT 137
FULLERTON CA
92831-1534
US

V. Phone/Fax

Practice location:
  • Phone: 562-365-2020
  • Fax:
Mailing address:
  • Phone: 714-397-4502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number107640
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number107640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: