Provider Demographics
NPI:1407159353
Name:KELLY, KATHRYN E (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:E
Last Name:KELLY
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-4612
Mailing Address - Country:US
Mailing Address - Phone:318-581-0128
Mailing Address - Fax:
Practice Address - Street 1:311 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-4612
Practice Address - Country:US
Practice Address - Phone:318-581-0128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1018103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist