Provider Demographics
NPI:1386065407
Name:CALLAWAY, KELLI MICHELLE
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:MICHELLE
Last Name:CALLAWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4538 W. CRAIG RD. STE, 290
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-7200
Mailing Address - Country:US
Mailing Address - Phone:702-486-5522
Mailing Address - Fax:
Practice Address - Street 1:4538 W CRAIG RD STE 290
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-2511
Practice Address - Country:US
Practice Address - Phone:702-486-5610
Practice Address - Fax:702-486-5630
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP1155101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health