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General NPI Number Information
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NPI Number | 1992298111
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Entity Type | Individual
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Provider Name | TRACY KELLAR CDCA
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Gender | Female
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 06/12/2018
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Provider Practice Location Address
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Address Line | 1 ROSS PARK BLVD STE 201
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City | STEUBENVILLE
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State | OH
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Zip | 43952-2671
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Country | US
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Telephone | 740-264-7751
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Fax | 740-264-2422
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Provider Business Mailing Address
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Address Line | 1 ROSS PARK BLVD STE 201
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City | STEUBENVILLE
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State | OH
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Zip | 43952-2671
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Country | US
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Telephone | 740-264-7751
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Fax | 740-264-2422
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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