MEDICARE: KELLY WHITLEY

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1285033985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY WHITLEY

Provider Business Mailing Address
First Line	:	8548 SWEET CEDAR AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143-5186
Country	:	US
Telephone Number	:	702-403-8759
Fax Number	:

Provider Business Practice Location Address
First Line	:	8548 SWEET CEDAR AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143-5186
Country	:	US
Telephone Number	:	702-403-8759
Fax Number	:

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

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	08/19/2014

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Directions to “ KELLY WHITLEY ” Practice Location

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