Healthcare Provider Details

I. General information

NPI: 1992215271
Provider Name (Legal Business Name): KELLY D CHANCE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY D ADKINS LCSW

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 LAKE AVE
SAINT JOSEPH MO
64504-1170
US

IV. Provider business mailing address

724 N 22ND ST
SAINT JOSEPH MO
64506-2604
US

V. Phone/Fax

Practice location:
  • Phone: 816-238-7788
  • Fax: 816-238-9298
Mailing address:
  • Phone: 816-261-4939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2020000664
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2017017986
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: