Healthcare Provider Details

I. General information

NPI: 1629400627
Provider Name (Legal Business Name): KELLY ANN HAVLIN M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 E GREEN ST STE 205
PASADENA CA
91101-5405
US

IV. Provider business mailing address

776 E GREEN ST STE 205
PASADENA CA
91101-5405
US

V. Phone/Fax

Practice location:
  • Phone: 626-765-7506
  • Fax:
Mailing address:
  • Phone: 626-765-7506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number104473
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: