Individual
MR. MOISE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
455 S MESA DR UNIT 142, MESA, AZ 85210-2711
(480) 277-0313
Mailing address
455 S MESA DR UNIT 142, MESA, AZ 85210-2711
(480) 616-3323
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
957399
AZ
104100000X
Social Worker
957399
AZ
171M00000X
Case Manager/Care Coordinator
957399
AZ
172V00000X
Community Health Worker
Primary
957399
AZ
174H00000X
Health Educator
957399
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
957399
—
AZ
Enumeration date
02/04/2015
Last updated
07/16/2019
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