Provider Demographics
NPI:1770014722
Name:NELY, KATHRYN MICHELLE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MICHELLE
Last Name:NELY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 EAST ELM STREET
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401
Mailing Address - Country:US
Mailing Address - Phone:785-825-6224
Mailing Address - Fax:785-825-7595
Practice Address - Street 1:617 EAST ELM STREET
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401
Practice Address - Country:US
Practice Address - Phone:785-825-6224
Practice Address - Fax:785-825-7595
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1258101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)