Healthcare Provider Details

I. General information

NPI: 1962043158
Provider Name (Legal Business Name): KELSEY JA'NET CONNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2439 MANHATTAN BLVD STE 207
HARVEY LA
70058-5361
US

IV. Provider business mailing address

72 DIALITA DR
AVONDALE LA
70094-2839
US

V. Phone/Fax

Practice location:
  • Phone: 504-364-8949
  • Fax:
Mailing address:
  • Phone: 504-518-1907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number011268510
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number18874
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: