Provider Demographics
NPI:1427861566
Name:STRAWN, KERILEI R (CTC - NCCA)
Entity type:Individual
Prefix:
First Name:KERILEI
Middle Name:R
Last Name:STRAWN
Suffix:
Gender:F
Credentials:CTC - NCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 N YAVAPAI DR
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-5061
Mailing Address - Country:US
Mailing Address - Phone:480-283-0111
Mailing Address - Fax:
Practice Address - Street 1:2014 N YAVAPAI DR
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-5061
Practice Address - Country:US
Practice Address - Phone:480-283-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23903101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral