Provider Demographics
NPI:1700063054
Name:KELLEMS, IAN STUART (PHD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:STUART
Last Name:KELLEMS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 MAPLE DR
Mailing Address - Street 2:SUITE1
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-0809
Mailing Address - Country:US
Mailing Address - Phone:304-599-5751
Mailing Address - Fax:304-599-2124
Practice Address - Street 1:1062 MAPLE DR
Practice Address - Street 2:SUITE1
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-0809
Practice Address - Country:US
Practice Address - Phone:304-599-5751
Practice Address - Fax:304-599-2124
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV960103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist