Provider Demographics
NPI:1720369291
Name:DAVIS, KELLY (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8826 SANTA FE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-3672
Mailing Address - Country:US
Mailing Address - Phone:816-945-2317
Mailing Address - Fax:913-499-8666
Practice Address - Street 1:8826 SANTA FE DR STE 210
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-3672
Practice Address - Country:US
Practice Address - Phone:816-945-2317
Practice Address - Fax:913-499-8666
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1255106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist