Provider Demographics
NPI:1689333916
Name:BARKLEY, KELITTA
Entity Type:Individual
Prefix:
First Name:KELITTA
Middle Name:
Last Name:BARKLEY
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 1:13413 THORNHURST AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6848
Mailing Address - Country:US
Mailing Address - Phone:216-501-0059
Mailing Address - Fax:
Practice Address - Street 1:1507 SAINT CLAIR AVE NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2003
Practice Address - Country:US
Practice Address - Phone:216-451-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator