Debra J Kelly, MFT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MFC19530 Issued in CA

Practice address

114 Sotoyome St
Santa Rosa, CA 95405-4804

Phone

(707) 569-0459

Fax

(707) 570-3941

NPI assigned

Jun 18, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339977600000",
    "number": "1093078867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 SOTOYOME ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054804",
            "telephone_number": "707-569-0459",
            "fax_number": "707-570-3941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 SOTOYOME ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054804",
            "telephone_number": "707-569-0459",
            "fax_number": "707-570-3941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "DEBRA",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-18",
        "last_updated": "2012-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "MFC19530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas McNeese Keller, M.D., M.P.H.
• Anjuli Dillon Kelley, MSOT
• Jessica Kelley
• Mary Frances Kelley, PT
• Rachel T Kelley, MS
• Jeanne M. Kelly, R.N.
• Katrin Kelly
• Sonya Maria Kelly, PHD
• Tina Marie Kelly, LMFT
• Marjorie L. Kelvin, MD

• Mental Health Counselor in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.