MEDICARE: DR. MICHAEL O'HARA KELLEY PH.D., MFT

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	106H00000X	Marriage & Family Therapist	MFC 36367	CA

General Provider Information

NPI Number	:	1649351933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL O'HARA KELLEY PH.D., MFT

Provider Business Mailing Address
First Line	:	690 W FREMONT AVE STE 6
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-4202
Country	:	US
Telephone Number	:	408-739-4000
Fax Number	:	408-738-6607

Provider Business Practice Location Address
First Line	:	690 W FREMONT AVE STE 6
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-4202
Country	:	US
Telephone Number	:	408-739-4000
Fax Number	:	408-738-6607

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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