Individual
KELLIE CLEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
182 SW ACADEMY ST, DALLAS, OR 97338-1996
(503) 623-9289
Mailing address
643 NW 10TH ST, CORVALLIS, OR 97330-6111
(971) 409-2043
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
C7151
OR
Other
Enumeration date
06/04/2019
Last updated
11/27/2024
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