Individual
KELLEY MIRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6392 W 300 S, NEW PALESTINE, IN 46163-9748
(317) 340-9875
Mailing address
6392 W 300 S, NEW PALESTINE, IN 46163-9748
(317) 340-9875
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201033170 A
—
IN
Enumeration date
08/20/2014
Last updated
08/20/2014
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