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NPI Code Detail

MEDICARE: KYRIE NEELEY

MEDICARE: KYRIE NEELEY
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
1101YP2500XProfessional CounselorE.1000657OH
2101YM0800XMental Health CounselorC4681OR

General Provider Information

NPI Number : 1497191555
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYRIE NEELEY
Provider Business Mailing Address
First Line : 255 LANCASTER DR NE
Second Line :
City : SALEM
State : OR
Zip : 97301-5155
Country : US
Telephone Number : 503-364-0775
Fax Number : 503-576-8400
Provider Business Practice Location Address
First Line : 255 LANCASTER DR NE
Second Line :
City : SALEM
State : OR
Zip : 97301-5155
Country : US
Telephone Number : 503-364-0775
Fax Number : 503-576-8400
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2013
Last Update Date : 03/22/2021

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Directions to “ KYRIE NEELEY ” Practice Location

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