Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1154613271 |
---|---|
Provider Name | Miss Kristan Kelly |
First Address | Las Vegas, NV 89166-5234 |
Second Address | Las Vegas, NV 89123-2839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2011 |
Last Update Date | 23/10/2018 |