MEDICARE: MR. KELLY BRIAN KOCHELL LCSW, LMFT

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
1	1041C0700X	Clinical Social Worker	34002771A	IN
2	106H00000X	Marriage & Family Therapist	35000120A	IN

General Provider Information

NPI Number	:	1336165398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KELLY BRIAN KOCHELL LCSW, LMFT

Provider Business Mailing Address
First Line	:	9292 N MERIDIAN ST STE 311
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1828
Country	:	US
Telephone Number	:	317-466-8833
Fax Number	:	317-255-7854

Provider Business Practice Location Address
First Line	:	9292 N MERIDIAN ST STE 311
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1828
Country	:	US
Telephone Number	:	317-466-8833
Fax Number	:	317-255-7854

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	09/11/2025

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