MEDICARE: MR. RICK JAMES KELLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	68420	CA
2	1041C0700X	Clinical Social Worker	89984	CA

General Provider Information

NPI Number	:	1124493861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICK JAMES KELLY

Provider Business Mailing Address
First Line	:	8950 CAL CENTER DR STE 340
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-3225
Country	:	US
Telephone Number	:	916-254-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	8950 CAL CENTER DR STE 340
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-3225
Country	:	US
Telephone Number	:	916-254-5200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2015
Last Update Date	:	06/27/2025

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Directions to “ MR. RICK JAMES KELLY ” Practice Location

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