Provider Demographics
NPI:1790209039
Name:HEON, KELLI
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:HEON
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 1:409 MAIN ST STE 121
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2347
Mailing Address - Country:US
Mailing Address - Phone:413-461-7120
Mailing Address - Fax:
Practice Address - Street 1:103 MECHANIC ST # 484
Practice Address - Street 2:
Practice Address - City:EAST BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01515-9800
Practice Address - Country:US
Practice Address - Phone:413-459-9565
Practice Address - Fax:833-431-1244
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty