Provider Demographics
NPI:1083886642
Name:FINN, KELLY MICHAEL (MSW, LISAC)
Entity Type:Individual
Prefix:MR
First Name:KELLY
Middle Name:MICHAEL
Last Name:FINN
Suffix:
Gender:M
Credentials:MSW, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5022 N 54TH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-7531
Mailing Address - Country:US
Mailing Address - Phone:623-931-4343
Mailing Address - Fax:623-939-3476
Practice Address - Street 1:5022 N 54TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-7531
Practice Address - Country:US
Practice Address - Phone:623-931-4343
Practice Address - Fax:623-939-3476
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10886101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ600248032OtherMAGELLAN PROVIDER ID NUMB