Healthcare Provider Details

I. General information

NPI: 1114380680
Provider Name (Legal Business Name): KELLY MOREHEAD PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 BURNET AVE STE 401
CINCINNATI OH
45219-2426
US

IV. Provider business mailing address

2825 AVE BURNET STE 401
CINCINNATI OH
45219
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-5823
  • Fax: 513-558-0214
Mailing address:
  • Phone: 513-558-5823
  • Fax: 513-558-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1100220
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: