Provider Demographics
NPI:1023455003
Name:SPRING, KEALY (MS)
Entity type:Individual
Prefix:
First Name:KEALY
Middle Name:
Last Name:SPRING
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 MARKET ST STE 1011
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-5311
Mailing Address - Country:US
Mailing Address - Phone:415-488-5139
Mailing Address - Fax:
Practice Address - Street 1:582 MARKET ST STE 1011
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-5311
Practice Address - Country:US
Practice Address - Phone:415-488-5139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2023-10-31
Deactivation Date:2014-06-24
Deactivation Code:
Reactivation Date:2018-10-31
Provider Licenses
StateLicense IDTaxonomies
CA93512106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist