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General NPI Number Information
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NPI Number | 1912882572
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Entity Type | Individual
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Provider Name | MR. RICHARD ARTHUR KELLY III
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Gender | Male
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Dates
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Enumeration Date | 08/11/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 307 S B ST
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City | SAN MATEO
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State | CA
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Zip | 94401-4053
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Country | US
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Telephone | 650-223-5605
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Fax |
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Provider Business Mailing Address
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Address Line | 545 MERIDIAN AVE UNIT 26008
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City | SAN JOSE
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State | CA
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Zip | 95159-1001
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT156871
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License Number State | CA
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