Provider Demographics
NPI:1295457596
Name:U'REN, KELBIE
Entity type:Individual
Prefix:
First Name:KELBIE
Middle Name:
Last Name:U'REN
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 1:5851 E MAYFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7881
Mailing Address - Country:US
Mailing Address - Phone:907-376-4000
Mailing Address - Fax:
Practice Address - Street 1:5851 E MAYFLOWER CT
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7881
Practice Address - Country:US
Practice Address - Phone:907-376-4000
Practice Address - Fax:907-373-1135
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC3983101YP2500X
AK195153101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional