Provider Demographics
NPI:1154021590
Name:KLIMAN, KELLY JO (LMFT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JO
Last Name:KLIMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 WAVERLY LN
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-3756
Mailing Address - Country:US
Mailing Address - Phone:650-575-6889
Mailing Address - Fax:
Practice Address - Street 1:763 ALTOS OAKS DR STE 2
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5400
Practice Address - Country:US
Practice Address - Phone:650-575-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135006106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist