Provider Demographics
NPI:1710684014
Name:KELBLEY, KAY LORRAINE (I0008635-SUPV)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:LORRAINE
Last Name:KELBLEY
Suffix:
Gender:F
Credentials:I0008635-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S SAINT CLAIR ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2143
Mailing Address - Country:US
Mailing Address - Phone:937-684-3303
Mailing Address - Fax:937-224-0847
Practice Address - Street 1:15 S SAINT CLAIR ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2143
Practice Address - Country:US
Practice Address - Phone:937-684-3303
Practice Address - Fax:937-224-0847
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker