Provider Demographics
NPI:1295220986
Name:KELLY REEVES MEMORIAL FOUNDATION
Entity Type:Organization
Organization Name:KELLY REEVES MEMORIAL FOUNDATION
Other - Org Name:KELLY'S GRIEF CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAIR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:330-593-5959
Mailing Address - Street 1:135 E ERIE ST STE 302
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-3594
Mailing Address - Country:US
Mailing Address - Phone:330-593-5959
Mailing Address - Fax:
Practice Address - Street 1:135 E ERIE ST STE 302
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-3594
Practice Address - Country:US
Practice Address - Phone:330-593-5959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty