Healthcare Provider Details

I. General information

NPI: 1255128435
Provider Name (Legal Business Name): KELLEY HUNTER ELLIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8438 OAK ST STE B
NEW ORLEANS LA
70118-2046
US

IV. Provider business mailing address

215 FAIRWAY DR
NEW ORLEANS LA
70124-1018
US

V. Phone/Fax

Practice location:
  • Phone: 504-390-2132
  • Fax:
Mailing address:
  • Phone: 504-390-2132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5509
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5509
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: