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1710082979
TIMOTHY KEVIN KELLY
CLACKAMAS, OR
NPI
1710082979
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor Mental Health
(Licence: OR OR C0220)
Enumeration Date
2006-09-13
Last Update Date
2007-07-08
Business Address
MR. TIMOTHY KEVIN KELLY M.S.
10163 SE SUNNYSIDE RD STE 490
CLACKAMAS, OR 97015-5720
Phone number: 503-653-3451
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Mailing Address
MR. TIMOTHY KEVIN KELLY M.S.
4454 NE MASON ST
PORTLAND, OR 97218-1739
Phone number: 503-254-7996
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