Kellen Dean
Community/Behavioral Health in Bloomfield, NM. Individual provider (NPI-1).
NPI number1962010199
StatusActive
Last updated in NPPESJan 19, 2023
Details
- NPI
- 1962010199
- Entity type
- Individual (NPI-1)
- Name
- Kellen Dean
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jul 14, 2020
- Certification date
- Jan 19, 2023
- Last updated
- Jan 19, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | – | – | Yes |
Practice location
101 E Broadway AveBloomfield, NM 87413-6235
Phone 505-330-8220
Mailing address
101 E Broadway AveBloomfield, NM 87413-6235
Phone 505-947-4384
Other practice locations
114 N Behrend Ave
Farmington, NM 87401-8414
Farmington, NM 87401-8414
Phone 505-330-8220 · Fax 505-234-7867
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