Individual
KELLI HUNTINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADC-I
Contact information
Practice address
461 NE GREENWOOD AVE, STE A, BEND, OR 97701-4607
(541) 617-7365
(541) 312-6343
Mailing address
461 NE GREENWOOD AVE, STE A, BEND, OR 97701-4607
(541) 617-7365
(541) 312-6343
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3901428
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210831
—
OR
Enumeration date
04/27/2010
Last updated
04/27/2010
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