Provider Demographics
NPI:1932854007
Name:CLAVIN-KEIM, KELLY NICHOLE (LCPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:NICHOLE
Last Name:CLAVIN-KEIM
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:NICHOLE
Other - Last Name:CLAVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:440 N PARK AVE APT A6
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5024
Mailing Address - Country:US
Mailing Address - Phone:406-202-0326
Mailing Address - Fax:
Practice Address - Street 1:25 S EWING ST STE 511
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5732
Practice Address - Country:US
Practice Address - Phone:406-202-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT55178101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty