Provider Demographics
NPI:1356839922
Name:TONDRE, KELI KAE
Entity Type:Individual
Prefix:
First Name:KELI
Middle Name:KAE
Last Name:TONDRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 DISCOVERY DR STE 211
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6995
Mailing Address - Country:US
Mailing Address - Phone:406-209-3262
Mailing Address - Fax:
Practice Address - Street 1:141 DISCOVERY DR STE 211
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6995
Practice Address - Country:US
Practice Address - Phone:406-209-3262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-28
Last Update Date:2018-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-30232101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional