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General NPI Number Information
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NPI Number | 1700170776
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Entity Type | Individual
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Provider Name | KELLY IRVING LMSW
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Gender | Female
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Dates
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Enumeration Date | 06/07/2011
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Last Update Date | 06/07/2011
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Provider Practice Location Address
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Address Line | 700 N 7TH AVE
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City | TUCSON
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State | AZ
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Zip | 85705-8307
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Country | US
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Telephone | 520-202-1717
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Fax | 520-202-1702
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Provider Business Mailing Address
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Address Line | 1650 E FORT LOWELL RD SUITE 202
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City | TUCSON
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State | AZ
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Zip | 85719-2374
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Country | US
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Telephone | 520-202-1717
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Fax | 520-202-1702
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW-12696
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License Number State | AZ
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