Provider Demographics
NPI:1952051666
Name:BRINSON-KELLEY, SIERRA (CH-C)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:BRINSON-KELLEY
Suffix:
Gender:F
Credentials:CH-C
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:
Other - Last Name:BRINSON-KELLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CH-C SIERRA KELLEY
Mailing Address - Street 1:11655 JOSEPH CAMPAU ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3046
Mailing Address - Country:US
Mailing Address - Phone:131-324-6555
Mailing Address - Fax:
Practice Address - Street 1:11655 JOSEPH CAMPAU ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3046
Practice Address - Country:US
Practice Address - Phone:313-246-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty