Individual
MR. MOISE KELLY
Active
Individual
MR. MOISE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
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
Update your record
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