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General NPI Number Information
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NPI Number | 1326729641
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Entity Type | Individual
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Provider Name | ASHLEY NICOLE KELLEM MA
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Gender | Female
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Dates
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Enumeration Date | 07/28/2023
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 1500 OWENS ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94158-2334
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Country | US
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Telephone | 415-353-2808
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Fax |
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Provider Business Mailing Address
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Address Line | 6160 BALTIMORE AVE
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City | PORT ST JOHN
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State | FL
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Zip | 32927-7812
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 14209
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 140415
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License Number State | CA
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