MEDICARE: TALISHA MONIC KELLY LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	2125	NC

General Provider Information

NPI Number	:	1144795246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALISHA MONIC KELLY LMFT

Provider Business Mailing Address
First Line	:	635 HILLGROVE LN
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-8385
Country	:	US
Telephone Number	:	919-696-2733
Fax Number	:

Provider Business Practice Location Address
First Line	:	3515 DAVID COX RD UNIT 481321
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-2537
Country	:	US
Telephone Number	:	704-336-0366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2018
Last Update Date	:	07/10/2023

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Directions to “ TALISHA MONIC KELLY LMFT” Practice Location

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