Provider Demographics
NPI:1265928451
Name:CASEY-STEVENS, KELLY LEE (CAODC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LEE
Last Name:CASEY-STEVENS
Suffix:
Gender:F
Credentials:CAODC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 WOODHAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4615
Mailing Address - Country:US
Mailing Address - Phone:916-214-8630
Mailing Address - Fax:
Practice Address - Street 1:1133 COLOMA WAY STE C
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4480
Practice Address - Country:US
Practice Address - Phone:916-744-6647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)