Provider Demographics
NPI:1164783783
Name:CONNOT, KELLY DAVIS (LMHP, NCC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DAVIS
Last Name:CONNOT
Suffix:
Gender:F
Credentials:LMHP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11774 POLYLINE RD
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-1585
Mailing Address - Country:US
Mailing Address - Phone:402-322-0271
Mailing Address - Fax:
Practice Address - Street 1:11774 POLYLINE RD
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-1585
Practice Address - Country:US
Practice Address - Phone:402-322-0271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health