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NPI Code Detail

MEDICARE: DARLENE SUE KELLEY LPCC CCDCIII

MEDICARE: DARLENE SUE KELLEY LPCC CCDCIII
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
1101YA0400XAddiction (Substance Use Disorder) CounselorE943900OH
2101YM0800XMental Health Counselor103162KY
3101YP2500XProfessional Counselor1536KY
4101YM0800XMental Health CounselorE280OH

General Provider Information

NPI Number : 1407821978
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARLENE SUE KELLEY LPCC CCDCIII
Provider Business Mailing Address
First Line : 48 SPRINGSIDE DR
Second Line :
City : COLD SPRING
State : KY
Zip : 41076-1900
Country : US
Telephone Number : 859-760-2229
Fax Number :
Provider Business Practice Location Address
First Line : 2211 FULTON AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45206-2504
Country : US
Telephone Number : 513-961-4663
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2006
Last Update Date : 03/26/2020

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