Provider Demographics
NPI:1932601085
Name:SMITH-YANCEY, KELLY DEE (MSW)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:DEE
Last Name:SMITH-YANCEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LETTON DR
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-4366
Mailing Address - Country:US
Mailing Address - Phone:575-383-2069
Mailing Address - Fax:575-347-1190
Practice Address - Street 1:101 LETTON DR
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-4366
Practice Address - Country:US
Practice Address - Phone:575-383-2069
Practice Address - Fax:575-347-1190
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker