Individual
KELLEY O'DONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CAC III, ATP
Contact information
Practice address
4485 WADSWORTH BLVD, SUITE 206, WHEAT RIDGE, CO 80033-3310
(303) 431-5664
(303) 431-6713
Mailing address
4485 WADSWORTH BLVD, SUITE 206, WHEAT RIDGE, CO 80033-3310
(303) 431-5664
(303) 431-6713
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACC 0007129
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ACC 0007129
CAC LICENSE
CO
Enumeration date
02/16/2017
Last updated
02/16/2017
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