Provider Demographics
NPI:1467840504
Name:ASANTE, KELLEY OWUSU (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:OWUSU
Last Name:ASANTE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KELLEY
Other - Middle Name:ANNE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, BC-TMH
Mailing Address - Street 1:100 RACCOON TRCE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4021
Mailing Address - Country:US
Mailing Address - Phone:256-684-1700
Mailing Address - Fax:
Practice Address - Street 1:100 RACCOON TRCE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4021
Practice Address - Country:US
Practice Address - Phone:256-684-1700
Practice Address - Fax:888-439-5222
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3672101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1467840504Medicaid