Provider Demographics
NPI:1659703676
Name:SEARS, KELLI (PHD)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:SEARS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 HILL RD N
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7989
Mailing Address - Country:US
Mailing Address - Phone:614-604-6067
Mailing Address - Fax:614-604-6529
Practice Address - Street 1:1241 HILL RD N
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7989
Practice Address - Country:US
Practice Address - Phone:614-604-6067
Practice Address - Fax:614-604-6529
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP592103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0373157Medicaid