Provider Demographics
NPI:1760610802
Name:HUSE, KELLEY MCCALL
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:MCCALL
Last Name:HUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:MCCALL
Other - Last Name:HUSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:9700 N DOUGLAS HWY
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7663
Mailing Address - Country:US
Mailing Address - Phone:907-209-0900
Mailing Address - Fax:
Practice Address - Street 1:9700 N DOUGLAS HWY
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7663
Practice Address - Country:US
Practice Address - Phone:907-209-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-28
Last Update Date:2023-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8111041C0700X
AKAA8111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical