Provider Demographics
NPI:1033490495
Name:KELLY, CATHERINA ANNETTE (LSCSW)
Entity Type:Individual
Prefix:MS
First Name:CATHERINA
Middle Name:ANNETTE
Last Name:KELLY
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 COLLEGE BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-2430
Mailing Address - Country:US
Mailing Address - Phone:913-912-9769
Mailing Address - Fax:
Practice Address - Street 1:6201 COLLEGE BLVD STE 410
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-2430
Practice Address - Country:US
Practice Address - Phone:913-652-6668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5582104100000X
KS41131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker