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NPI Code Detail

MEDICARE: MS. KELLY LORRAINE SHIVELY LPC

MEDICARE: MS. KELLY LORRAINE SHIVELY LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor1942KS

General Provider Information

NPI Number : 1255524229
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLY LORRAINE SHIVELY LPC
Provider Business Mailing Address
First Line : 1738 S MARTINSON
Second Line :
City : WICHITA
State : KS
Zip : 67213-5799
Country : US
Telephone Number : 316-293-9547
Fax Number : 316-691-8473
Provider Business Practice Location Address
First Line : 1738 S MARTINSON
Second Line :
City : WICHITA
State : KS
Zip : 67213-5799
Country : US
Telephone Number : 316-293-9547
Fax Number : 316-691-8473
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2007
Last Update Date : 09/05/2012

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Directions to “ MS. KELLY LORRAINE SHIVELY LPC” Practice Location

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