Provider Demographics
NPI:1205643079
Name:HALLAM, KELLIE L (BMS)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:L
Last Name:HALLAM
Suffix:
Gender:F
Credentials:BMS
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:L
Other - Last Name:BIEHUNKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4730 BECKNER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3691
Mailing Address - Country:US
Mailing Address - Phone:505-989-4500
Mailing Address - Fax:
Practice Address - Street 1:4730 BECKNER RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3691
Practice Address - Country:US
Practice Address - Phone:505-989-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician