Provider Demographics
NPI:1184036386
Name:KELLY ZHOU MSW, LLC
Entity Type:Organization
Organization Name:KELLY ZHOU MSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZHOU
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:314-502-9444
Mailing Address - Street 1:2211 S BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1803
Mailing Address - Country:US
Mailing Address - Phone:314-502-9444
Mailing Address - Fax:
Practice Address - Street 1:2211 S BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-1803
Practice Address - Country:US
Practice Address - Phone:314-502-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011032268104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty