Individual
MS. KELLI D SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADAC
Contact information
Practice address
100 WARRIOR DRIVE, RUIDOSO, NM 88345
(505) 258-4859
(505) 258-3320
Mailing address
1400 SUDDERTH DR, RUIDOSO, NM 88345-6103
(505) 258-4859
(505) 258-3320
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3439
NM
Other
Enumeration date
12/11/2006
Last updated
07/08/2007
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