Provider Demographics
NPI:1013396050
Name:ENGLISH, KELLE
Entity Type:Individual
Prefix:
First Name:KELLE
Middle Name:
Last Name:ENGLISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 S 7TH AVE
Mailing Address - Street 2:BLDG. C
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-3902
Mailing Address - Country:US
Mailing Address - Phone:602-258-3600
Mailing Address - Fax:602-256-0514
Practice Address - Street 1:1424 S 7TH AVE
Practice Address - Street 2:BLDG. C
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-3902
Practice Address - Country:US
Practice Address - Phone:602-258-3600
Practice Address - Fax:602-256-0514
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11631101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGOtherPENDING