Kelly, Timothy

Kelly, Timothy is an individual health care provider with primary practice located at 8411 Broadway Ave Ste 3932 , Cleveland OH 44105-3932. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Social Worker, Other Service Providers / Peer Specialist. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is his primary health care specialty. Kelly, Timothy can be contacted via phone (216) 441-0200.

Contact Information

Primary practice address
8411 Broadway Ave Ste 3932 Cleveland OH 44105-3932
Phone: (216) 441-0200
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X CDCA.183151 Ohio
Behavioral Health & Social Service Providers / Social Worker 104100000X S.2202740-TRNE Ohio
Other Service Providers / Peer Specialist 175T00000X Ohio
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X

Profile Details

NPI number 1083188643
LBN Legal business name Kelly, Timothy
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 17th, 2019
Last updated Apr 19th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083188643 NPPES
Ohio MEDICAID 1083188643
Ohio MEDICAID 17500000X

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