Provider Demographics
NPI:1275774697
Name:KELLY, JILL SCHEXNAILDRE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:SCHEXNAILDRE
Last Name:KELLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3122 OCTAVIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-4936
Mailing Address - Country:US
Mailing Address - Phone:504-615-5333
Mailing Address - Fax:
Practice Address - Street 1:3705 COLISEUM ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3708
Practice Address - Country:US
Practice Address - Phone:504-615-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-14
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3497101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health