Provider Demographics
NPI:1225221369
Name:KELLY, LAUREN MAI (MA)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:MAI
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 S KIHEI RD
Mailing Address - Street 2:237
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-9070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:715 S KIHEI RD
Practice Address - Street 2:237
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-9070
Practice Address - Country:US
Practice Address - Phone:401-316-9666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30343OtherBLUE CROSS CRISIS