Provider Demographics
NPI:1124493861
Name:KELLY, RICK JAMES
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:JAMES
Last Name:KELLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 COHASSET RD
Mailing Address - Street 2:175
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2281
Mailing Address - Country:US
Mailing Address - Phone:530-891-2784
Mailing Address - Fax:
Practice Address - Street 1:560 COHASSET RD
Practice Address - Street 2:175
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2281
Practice Address - Country:US
Practice Address - Phone:530-891-2784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68420101YM0800X
CA899841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health