Provider Demographics
NPI:1821467507
Name:KELLY, BRANDI (LPC, LMFT, NCC)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:LPC, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 KILPATRICK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5156
Mailing Address - Country:US
Mailing Address - Phone:318-325-8050
Mailing Address - Fax:
Practice Address - Street 1:3100 KILPATRICK BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5156
Practice Address - Country:US
Practice Address - Phone:318-325-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2543101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional