Provider Demographics
NPI:1972279370
Name:ALISHA KELLEY LCSW,LLC
Entity Type:Organization
Organization Name:ALISHA KELLEY LCSW,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:INEZ
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-358-2146
Mailing Address - Street 1:401 NE 19TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-4800
Mailing Address - Country:US
Mailing Address - Phone:503-358-2146
Mailing Address - Fax:
Practice Address - Street 1:401 NE 19TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-4800
Practice Address - Country:US
Practice Address - Phone:971-377-9506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty