Provider Demographics
NPI:1013713320
Name:KELLEY, NATASHA M (LSW)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:M
Last Name:KELLEY
Suffix:
Gender:
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 ALOUETTE DR APT 921
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8150
Mailing Address - Country:US
Mailing Address - Phone:203-326-0196
Mailing Address - Fax:
Practice Address - Street 1:2950 ALOUETTE DR APT 921
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8150
Practice Address - Country:US
Practice Address - Phone:203-326-0196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.115887104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker