Provider Demographics
NPI:1558558056
Name:MARLEY-SMITH, KELLY LYN (LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYN
Last Name:MARLEY-SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4034 E LOS ALTOS DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-3567
Mailing Address - Country:US
Mailing Address - Phone:480-695-9092
Mailing Address - Fax:
Practice Address - Street 1:1425 W ELLIOT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5129
Practice Address - Country:US
Practice Address - Phone:480-695-9092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC11065101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor