MR. TIMOTHY KELLY NPI 1083188643

NPI Information

NPI: 1083188643
Provider Name: MR. TIMOTHY KELLY
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
8411 BROADWAY AVE STE 3932
CLEVELAND, OH
ZIP 44105
Phone: (216) 441-0200
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MR. Timothy Kelly is an addiction (substance use disorder) counselor in Cleveland, OH. MR. Timothy Kelly NPI is 1083188643. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

8411 BROADWAY AVE STE 3932
CLEVELAND, OH
ZIP 44105-932
Phone: (216) 441-0200

The enumeration date for this NPI number is 1/17/2019 and was last updated on 4/19/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	CDCA.183151	OHIO	No
2	104100000X	Social Worker		S.2202740-TRNE	OHIO	No
3	175T00000X	Peer Specialist			OHIO	No
4	101YA0400X	Counselor	Addiction (Substance Use Disorder)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1083188643	MEDICAID	OHIO
2	17500000X	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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