Provider Demographics
NPI:1629585989
Name:KELLEY CASEY LLC
Entity Type:Organization
Organization Name:KELLEY CASEY LLC
Other - Org Name:KELLEY CASEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INDEPENDENT SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-956-7793
Mailing Address - Street 1:2911 A W GRIMES BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5459
Mailing Address - Country:US
Mailing Address - Phone:512-956-7793
Mailing Address - Fax:
Practice Address - Street 1:2911 A W GRIMES BLVD STE 204
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-5459
Practice Address - Country:US
Practice Address - Phone:512-956-7793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63605251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health