Provider Demographics
NPI:1790568210
Name:ADAMS, KELLY ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:KLAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:22119 EMERALD RUN LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-6356
Mailing Address - Country:US
Mailing Address - Phone:832-216-6077
Mailing Address - Fax:
Practice Address - Street 1:22119 EMERALD RUN LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-6356
Practice Address - Country:US
Practice Address - Phone:832-216-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX694431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical