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NPI Code Detail

MEDICARE: RACHEL TESS KELLY CDCA

MEDICARE: RACHEL TESS KELLY CDCA
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.184883OH

General Provider Information

NPI Number : 1881462596
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHEL TESS KELLY CDCA
Provider Business Mailing Address
First Line : 23412 COMMERCE PARK
Second Line :
City : BEACHWOOD
State : OH
Zip : 44122-5813
Country : US
Telephone Number : 216-400-6640
Fax Number :
Provider Business Practice Location Address
First Line : 23412 COMMERCE PARK
Second Line :
City : BEACHWOOD
State : OH
Zip : 44122-5813
Country : US
Telephone Number : 216-400-6640
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2023
Last Update Date : 12/13/2023

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Directions to “ RACHEL TESS KELLY CDCA” Practice Location

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