Provider Demographics
NPI:1134761661
Name:RAMELLA, KERRY JEAN (PHD, LPC)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:JEAN
Last Name:RAMELLA
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7236 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-8080
Mailing Address - Country:US
Mailing Address - Phone:602-550-7001
Mailing Address - Fax:602-466-9456
Practice Address - Street 1:809 W MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-1325
Practice Address - Country:US
Practice Address - Phone:602-550-7001
Practice Address - Fax:602-466-9456
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-14465101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional