Healthcare Provider Details

I. General information

NPI: 1093659773
Provider Name (Legal Business Name): KELLY ELEDGE LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E ARMOUR BLVD APT 111
KANSAS CITY MO
64111-1290
US

IV. Provider business mailing address

350 E ARMOUR BLVD APT 111
KANSAS CITY MO
64111-1290
US

V. Phone/Fax

Practice location:
  • Phone: 888-289-8856
  • Fax:
Mailing address:
  • Phone: 888-289-8856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MISS KELLY MARIE ELEDGE
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCSW
Phone: 888-289-8856