Individual
KELLI KETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
101 S EISENHOWER DR, BECKLEY, WV 25801-4929
(304) 256-7144
Mailing address
1003 PINEWOOD DR, BECKLEY, WV 25801-2420
(304) 575-1765
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
DP00945104
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DP00945104
SOCIAL WORK LICENSE
WV
Enumeration date
04/02/2020
Last updated
11/27/2023
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