Healthcare Provider Details

I. General information

NPI: 1124632229
Provider Name (Legal Business Name): KELLI RUE-BACHINI LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLI FARMER

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 19TH ST S
BIRMINGHAM AL
35233-1927
US

IV. Provider business mailing address

3430 HIGHWAY 247
TUSCUMBIA AL
35674-6671
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-8101
  • Fax:
Mailing address:
  • Phone: 843-330-3462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4489G
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5688C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: