Provider Demographics
NPI:1346882420
Name:KELLEY, RICHARD DANIEL (BS,ACT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DANIEL
Last Name:KELLEY
Suffix:
Gender:M
Credentials:BS,ACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-1917
Mailing Address - Country:US
Mailing Address - Phone:307-689-5730
Mailing Address - Fax:
Practice Address - Street 1:211 4TH ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-1917
Practice Address - Country:US
Practice Address - Phone:605-697-2874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD01433282OtherDRIVERS LICENSE