MEDICARE: SHANICE KELLEY LCSW

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	109526	TX

General Provider Information

NPI Number	:	1912857889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANICE KELLEY LCSW

Provider Business Mailing Address
First Line	:	6611 ABODE AVE APT 22203
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76502-4712
Country	:	US
Telephone Number	:	254-721-6418
Fax Number	:

Provider Business Practice Location Address
First Line	:	6611 ABODE AVE APT 22203
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76502-4712
Country	:	US
Telephone Number	:	254-721-6418
Fax Number	:

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

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/30/2026

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Directions to “ SHANICE KELLEY LCSW” Practice Location

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