Provider Demographics
NPI:1194068627
Name:KELLY, EMMALYNN A
Entity type:Individual
Prefix:
First Name:EMMALYNN
Middle Name:A
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 HOLLIPAT CENTER DR
Mailing Address - Street 2:APT 12
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2459
Mailing Address - Country:US
Mailing Address - Phone:320-491-8937
Mailing Address - Fax:
Practice Address - Street 1:330 HOLLIPAT CENTER DR
Practice Address - Street 2:APT 12
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2459
Practice Address - Country:US
Practice Address - Phone:320-491-8937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist