MEDICARE: MS. KAREN KELLY PH.D., LPC, NCC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	500575	GA
2	101YM0800X	Mental Health Counselor	LPC003315	GA

General Provider Information

NPI Number	:	1942346978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN KELLY PH.D., LPC, NCC

Provider Business Mailing Address
First Line	:	1954 AIRPORT RD
Second Line	:	SUITE 101
City	:	ATLANTA
State	:	GA
Zip	:	30341-4956
Country	:	US
Telephone Number	:	404-243-5576
Fax Number	:	404-243-6455

Provider Business Practice Location Address
First Line	:	1954 AIRPORT RD
Second Line	:	SUITE 101
City	:	ATLANTA
State	:	GA
Zip	:	30341-4956
Country	:	US
Telephone Number	:	404-243-5576
Fax Number	:	404-243-6455

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	11/16/2015

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