Provider Demographics
NPI:1417103250
Name:KELLEHER, CAROLYN MARGARET (LMFT)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MARGARET
Last Name:KELLEHER
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 1:546 HARTNELL ST
Mailing Address - Street 2:SUITE 2 C
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2817
Mailing Address - Country:US
Mailing Address - Phone:831-915-8856
Mailing Address - Fax:
Practice Address - Street 1:546 HARTNELL ST
Practice Address - Street 2:SUITE 2 C
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2817
Practice Address - Country:US
Practice Address - Phone:831-915-8856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 34156101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health