Provider Demographics
NPI:1477991800
Name:SAYER, KELLY (MS, LMHC, CADC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SAYER
Suffix:
Gender:M
Credentials:MS, LMHC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 CENTRAL AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4200
Mailing Address - Country:US
Mailing Address - Phone:515-576-8119
Mailing Address - Fax:844-570-5061
Practice Address - Street 1:1728 CENTRAL AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4200
Practice Address - Country:US
Practice Address - Phone:515-576-8119
Practice Address - Fax:844-570-5061
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01735101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0159608Medicaid
IA07466OtherWELLMARK BCBS