Provider Demographics
NPI:1780435669
Name:KELLEM, BARRY DEAN (CBHCM)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:DEAN
Last Name:KELLEM
Suffix:
Gender:M
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 ASHTON COVE TER
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-6126
Mailing Address - Country:US
Mailing Address - Phone:561-713-4766
Mailing Address - Fax:
Practice Address - Street 1:902 ASHTON COVE TER
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-6126
Practice Address - Country:US
Practice Address - Phone:561-713-4766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)