Provider Demographics
NPI:1720525272
Name:SILLS, KELLEY
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:SILLS
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:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:24945-0037
Mailing Address - Country:US
Mailing Address - Phone:304-832-4116
Mailing Address - Fax:
Practice Address - Street 1:158 ACADEMY DRIVE
Practice Address - Street 2:
Practice Address - City:PENCE SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:24962
Practice Address - Country:US
Practice Address - Phone:304-445-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV368101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health