Provider Demographics
NPI:1801105754
Name:O'HORO, KELLY JEAN (MC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:O'HORO
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2563 S VAL VISTA DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1804
Mailing Address - Country:US
Mailing Address - Phone:480-448-1076
Mailing Address - Fax:
Practice Address - Street 1:2563 S VAL VISTA DR
Practice Address - Street 2:SUITE 108
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1804
Practice Address - Country:US
Practice Address - Phone:480-448-1076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional