Provider Demographics
NPI:1114380680
Name:MOREHEAD, KELLY (PC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MOREHEAD
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 AVE BURNET
Mailing Address - Street 2:STE 401
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:513-558-5823
Mailing Address - Fax:513-558-0214
Practice Address - Street 1:2825 BURNET AVE
Practice Address - Street 2:STE 401
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2426
Practice Address - Country:US
Practice Address - Phone:513-558-5823
Practice Address - Fax:513-558-0214
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1100220101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health