Most Relevant Information
Provider Data
| NPI Number: | 1003535386 |
| Provider Name: | TIM RAY KELLY |
| Entity Type: | Individual |
| Taxonomy Code: | 175T00000X |
| Specialty: | Peer Specialist |
| License Number: | THW000106995 |
Most Important Dates
| Enumeration Date: | 08/22/2022 |
| Last Updated: | 08/22/2022 |
Provider Practice Location
1221 NW HIGHWAY 101 STE A
LINCOLN CITY
OR
973673351
Practice Location Phone/Fax
| Phone: | 4422441336 |
| Fax: |
Provider Mailing Location
1221 NW HIGHWAY 101 STE A
LINCOLN CITY
OR
973673351
Provider Mailing Phone/Fax
| Phone: | 9717275471 |
| Fax: |