Provider Demographics
NPI:1629759899
Name:HUGHES, KELLI D
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:D
Last Name:HUGHES
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 1:41372 HIGHWAY 184
Mailing Address - Street 2:
Mailing Address - City:MANCOS
Mailing Address - State:CO
Mailing Address - Zip Code:81328-9002
Mailing Address - Country:US
Mailing Address - Phone:197-074-9474
Mailing Address - Fax:
Practice Address - Street 1:41372 HIGHWAY 184
Practice Address - Street 2:
Practice Address - City:MANCOS
Practice Address - State:CO
Practice Address - Zip Code:81328-9002
Practice Address - Country:US
Practice Address - Phone:970-749-4742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician