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General NPI Number Information
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NPI Number | 1568706141
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Entity Type | Individual
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Provider Name | OPHELIA KELLY L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 2941 TERRY RD
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City | JACKSON
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State | MS
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Zip | 39212-3073
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Country | US
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Telephone | 601-373-0566
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Fax | 601-373-0566
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Provider Business Mailing Address
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Address Line | 105 MEADOWVIEW CIR
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City | CLINTON
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State | MS
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Zip | 39056-5907
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Country | US
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Telephone | 601-608-8680
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | W0803
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1820
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License Number State | MS
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