Provider Demographics
NPI:1356626477
Name:HUGHES, KELLY MICHELLE (LSCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MICHELLE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:LSCSW
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3320 PETERSON RD FAMILY PSYCHOLOGICAL SERVICE LLC
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049
Mailing Address - Country:US
Mailing Address - Phone:785-371-1414
Mailing Address - Fax:785-371-4519
Practice Address - Street 1:3320 PETERSON RD FAMILY PSYCHOLOGICAL SERVICE LLC
Practice Address - Street 2:SUITE 104
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-371-1414
Practice Address - Fax:785-371-4519
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140068631041C0700X
KS43591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1356626477Medicaid