Provider Demographics
NPI:1275960551
Name:KELLY, BRITTANY AIMEE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:AIMEE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 A ST
Mailing Address - Street 2:PO BOX 430
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-2622
Mailing Address - Country:US
Mailing Address - Phone:925-519-3974
Mailing Address - Fax:
Practice Address - Street 1:1102 A ST
Practice Address - Street 2:PO BOX 430
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-2622
Practice Address - Country:US
Practice Address - Phone:925-519-3974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASA612389171041C0700X
CALCSW1075521041C0700X
CAASW683191041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical