Provider Demographics
NPI:1023252475
Name:CORL, KELLI NICHOLE (MS)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:NICHOLE
Last Name:CORL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 VALLEY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-6042
Mailing Address - Country:US
Mailing Address - Phone:814-942-9425
Mailing Address - Fax:814-942-9725
Practice Address - Street 1:1815 VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6042
Practice Address - Country:US
Practice Address - Phone:814-942-9425
Practice Address - Fax:814-942-9725
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health