| NPI | 1689717159 |
|---|---|
| Former Name | TRACY J KELLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 26681) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2016-07-19 |