Individual
TERRY KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1716 UNIVERSITY AVE S, FAIRBANKS, AK 99709-4904
(907) 322-6940
(907) 455-4434
Mailing address
PO BOX 80282, FAIRBANKS, AK 99708-0282
(907) 322-6940
(907) 455-4434
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
488
AK
Other
Enumeration date
10/23/2006
Last updated
06/27/2012
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