Healthcare Provider Details

I. General information

NPI: 1154490316
Provider Name (Legal Business Name): BRAD KELLEY LCSW, LCAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N MARKET ST
LIBERTY IN
47353-8496
US

IV. Provider business mailing address

5653 WILLOW GROVE RD
CENTERVILLE IN
47330-9719
US

V. Phone/Fax

Practice location:
  • Phone: 765-458-5191
  • Fax: 765-458-7301
Mailing address:
  • Phone: 937-248-4680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000659A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34006759A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: