Provider Demographics
NPI:1568516060
Name:KELLEY, JOHN PAUL (QMHA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:KELLEY
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7916 N EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-6116
Mailing Address - Country:US
Mailing Address - Phone:503-737-7513
Mailing Address - Fax:
Practice Address - Street 1:709 NW EVERETT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3517
Practice Address - Country:US
Practice Address - Phone:503-737-7513
Practice Address - Fax:503-737-7513
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator