Individual
TYRONE L KELLEWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MHC
Contact information
Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-6001
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6001
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LH 60084686
WA
Other
Enumeration date
06/01/2009
Last updated
05/19/2021
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