Provider Demographics
NPI:1376575415
Name:HILL, KELLI D (PHD)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:D
Last Name:HILL
Suffix:
Gender:F
Credentials:PHD
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Other - Credentials:
Mailing Address - Street 1:8553 URBANDALE AVE
Mailing Address - Street 2:DES MOINES PASTORAL COUNSELING CENTER SUITE 110
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4108
Mailing Address - Country:US
Mailing Address - Phone:515-274-4006
Mailing Address - Fax:515-255-5697
Practice Address - Street 1:8553 URBANDALE AVE
Practice Address - Street 2:DES MOINES PASTORAL COUNSELING CENTER SUITE 110
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4108
Practice Address - Country:US
Practice Address - Phone:515-274-4006
Practice Address - Fax:515-255-5697
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA00906103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI51807Medicare ID - Type Unspecified