MEDICARE: KELLEY STORY LADC, CCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	13-R-34	OR

General Provider Information

NPI Number	:	1194862821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY STORY LADC, CCS

Provider Business Mailing Address
First Line	:	100 MULLINS DR STE C2
Second Line	:
City	:	LEBANON
State	:	OR
Zip	:	97355-2868
Country	:	US
Telephone Number	:	541-451-6388
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 MULLINS DR STE C2
Second Line	:
City	:	LEBANON
State	:	OR
Zip	:	97355-2868
Country	:	US
Telephone Number	:	541-451-6388
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	09/13/2018

Similar Medicare Providers

1316948862 — RICHARD HINDMARSH M.D.
Practice Location Address:

100 MULLINS DR STE C1
LEBANON, OR
97355-2868

Practice Phone: 541-451-7450
Practice Fax: 541-451-7454

1609817592 — DR. D. TIMOTHY MCCARLEY M.D.
Practice Location Address:

100 MULLINS DR STE C1
LEBANON, OR
97355-2868

Practice Phone: 541-451-7450
Practice Fax:

1497782205 — DR. JOHN E. HICKEY M.D.
Practice Location Address:

100 MULLINS DR STE C2
LEBANON, OR
97355-2868

Practice Phone: 541-451-6413
Practice Fax:

1518168814 — JAVAD SCOTT MASHKURI M.D.
Practice Location Address:

100 MULLINS DR STE C1
LEBANON, OR
97355-2868

Practice Phone: 541-451-7450
Practice Fax:

1093997710 — BENTON COUNTY
Practice Location Address:

100 MULLINS DR STE A1
LEBANON, OR
97355-2868

Practice Phone: 541-766-0200
Practice Fax: 541-766-6618

1306129614 — WANDA CAROL NEWSOME CNP
Practice Location Address:

100 MULLINS DR STE A1
LEBANON, OR
97355-2868

Practice Phone: 541-766-0200
Practice Fax: 541-766-6618

Directions to “ KELLEY STORY LADC, CCS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.