Provider Demographics
NPI:1437704673
Name:KELLY, MELISSA (LCSW, PPSC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:LCSW, PPSC
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 E TRUXTUN AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-5348
Mailing Address - Country:US
Mailing Address - Phone:661-852-5600
Mailing Address - Fax:
Practice Address - Street 1:7910 DOWNING AVE STE 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5016
Practice Address - Country:US
Practice Address - Phone:661-878-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1029611041C0700X
CAASW816541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical