Individual
KELLY EARLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
1500 N MESA RD, BELEN, NM 87002-8528
(505) 864-9113
(505) 861-3681
Mailing address
PO BOX 518, LOS LUNAS, NM 87031-0518
(505) 865-3350
(505) 865-4739
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
I-06404
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
90424581
—
NM
Enumeration date
03/29/2007
Last updated
07/08/2007
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