Healthcare Provider Details

I. General information

NPI: 1104929173
Provider Name (Legal Business Name): KELLY O'BRIEN CLANCEY M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1743 IVERSON WAY
SACRAMENTO CA
95835-1238
US

IV. Provider business mailing address

1743 IVERSON WAY
SACRAMENTO CA
95835-1238
US

V. Phone/Fax

Practice location:
  • Phone: 916-214-0148
  • Fax:
Mailing address:
  • Phone: 916-214-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number50379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: