Provider Demographics
NPI:1386742690
Name:KELLY, JOHANNA HELEN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:HELEN
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:JOHANNA
Other - Middle Name:HELEN
Other - Last Name:MALERICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4361 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6611
Mailing Address - Country:US
Mailing Address - Phone:925-201-6040
Mailing Address - Fax:925-201-6034
Practice Address - Street 1:4361 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6611
Practice Address - Country:US
Practice Address - Phone:925-201-6040
Practice Address - Fax:925-201-6034
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42072106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist