Individual
REBECCA LEAH KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1211 W TILL RD, FORT WAYNE, IN 46825-2145
(260) 750-5161
Mailing address
1211 W TILL RD, FORT WAYNE, IN 46825-2145
(260) 750-5161
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39004135A
IN
Other
Enumeration date
04/19/2023
Last updated
04/19/2023
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