Provider Demographics
NPI:1326256108
Name:KELLY, ERIN MICHELLE (MS)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MICHELLE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7440 N. ORACLE RD.
Mailing Address - Street 2:BUILDING #7
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704
Mailing Address - Country:US
Mailing Address - Phone:520-333-7618
Mailing Address - Fax:520-750-0056
Practice Address - Street 1:7440 N. ORACLE RD.
Practice Address - Street 2:BUILDING #7
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-333-7618
Practice Address - Fax:520-376-1730
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAMFT-10307106H00000X
IL208-000060106H00000X
AZLMFT-15784106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist