| Doctor Name: | DR. GARY BERNARD KELLEY |
| NPI Number: | 1013028653 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 2187 |
| Business Practice Address: | 33595 Bainbridge Rd Suite 102 Solon, OH - 441392942 |
| Business Phone Number: | 4493495445 |
| Business Fax Number: | 4403494779 |
| Mailing Address: | 33595 Bainbridge Rd, Suite 102 SOLON |
| State: | OH |
| Postal Code: | 441392942 |
| Phone Number: | 4493495445 |
| Fax Number: | 4403494779 |
| NPI Enumeration Date: | 08/31/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TA0400X |
| License Number: | 2187 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |