MEDICARE: ANTHONY KELLEY LMHP,LPC,PLADC

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	101YM0800X	Mental Health Counselor	8785	NE

General Provider Information

NPI Number	:	1407168974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY KELLEY LMHP,LPC,PLADC

Provider Business Mailing Address
First Line	:	2645 O ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68510-1340
Country	:	US
Telephone Number	:	402-310-0115
Fax Number	:

Provider Business Practice Location Address
First Line	:	2645 O ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68510-1340
Country	:	US
Telephone Number	:	402-477-4247
Fax Number	:

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

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	04/12/2013

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