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1205063187
GLEN E KELLEY
TACOMA, WA
NPI
1205063187
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
Enumeration Date
2009-06-17
Last Update Date
2009-06-17
Business Address
GLEN E KELLEY
315 MARTIN LUTHER KING JR WAY
TACOMA, WA 98405-4234
Phone number: 253-403-1000
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Mailing Address
GLEN E KELLEY
PO BOX 5299
TACOMA, WA 98415-0299
Phone number:
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