Provider Demographics
NPI:1528479508
Name:KELLEY, BETTY (MA)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 HYLO RD SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9104
Mailing Address - Country:US
Mailing Address - Phone:503-383-1738
Mailing Address - Fax:
Practice Address - Street 1:3482 LIBERTY RD S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4607
Practice Address - Country:US
Practice Address - Phone:503-383-1738
Practice Address - Fax:503-967-6552
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional