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General NPI Number Information
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NPI Number | 1689125494
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Entity Type | Organization
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Legal Business Name | KELLEY UNIDAS INC.
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 2645 O ST
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City | LINCOLN
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State | NE
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Zip | 68510-1340
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Country | US
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Telephone | 402-310-0115
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Fax | 402-277-4247
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Provider Business Mailing Address
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Address Line | 236 S 27TH ST
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City | LINCOLN
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State | NE
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Zip | 68510-1309
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Country | US
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Telephone | 402-310-0115
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Fax | 402-477-4247
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Authorized Official
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Title or Position | MENTAL HEALTH PRACTITIONER
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Name | MR. ANTHONY KELLEY
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Credential | LIMHP, LPC, LADC
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Telephone | 402-310-0115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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