MEDICARE: MS. BILLIE LOU 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	130018	AK

General Provider Information

NPI Number	:	1992270508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BILLIE LOU KELLEY LCSW

Provider Business Mailing Address
First Line	:	3900 AMBASSADOR DR FL 4
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5922
Country	:	US
Telephone Number	:	907-729-1179
Fax Number	:	907-729-1189

Provider Business Practice Location Address
First Line	:	3900 AMBASSADOR DR FL 4
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5922
Country	:	US
Telephone Number	:	907-729-1179
Fax Number	:	907-729-1189

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

Provider Enumeration Date	:	10/10/2018
Last Update Date	:	10/10/2018

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