Provider Demographics
NPI:1326558495
Name:KELLEY, CHERI ANN (LCSW INTERN)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:ANN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LCSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WHITNEY RANCH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3098
Mailing Address - Country:US
Mailing Address - Phone:702-527-5252
Mailing Address - Fax:702-527-5151
Practice Address - Street 1:1001 WHITNEY RANCH DR STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-3098
Practice Address - Country:US
Practice Address - Phone:702-527-5252
Practice Address - Fax:702-527-5151
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2401-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker