Doctor Name: | DR. CASEY WILLIAM KELLIHER |
NPI Number: | 1770857906 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSY.D. |
License Number: | 4908 |
Business Practice Address: | 416 Xenia Ave Yellow Springs, OH - 453871836 |
Business Phone Number: | 9377679171 |
Business Fax Number: | 9377679175 |
Mailing Address: | 416 Xenia Ave, YELLOW SPRINGS |
State: | OH |
Postal Code: | 453871836 |
Phone Number: | 9377679171 |
Fax Number: | 9377679175 |
NPI Enumeration Date: | 03/06/2012 |
NPI Last Update Date: | 03/06/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TA0400X |
License Number: | 4908 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |