Individual
DR. GARY BERNARD KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
6605 LIMBERLOST CT, SOLON, OH 44139-3100
(449) 349-5445
Mailing address
PO BOX 391662, SOLON, OH 44139-8662
(449) 349-5445
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
2187
OH
103TA0400X
Addiction (Substance Use Disorder) Psychologist
2187
OH
103TC1900X
Counseling Psychologist
Primary
2187
OH
103TS0200X
School Psychologist
2187
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0320996
—
OH
Enumeration date
08/31/2006
Last updated
10/25/2021
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