Provider Demographics
NPI:1437695061
Name:MOORE-KELM, AMY (MA, CT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MOORE-KELM
Suffix:
Gender:F
Credentials:MA, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 MOUNT CARMEL TOBASCO RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-3400
Mailing Address - Country:US
Mailing Address - Phone:513-528-3838
Mailing Address - Fax:
Practice Address - Street 1:4030 MOUNT CARMEL TOBASCO RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-3400
Practice Address - Country:US
Practice Address - Phone:513-528-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health