Provider Demographics
NPI:1023186731
Name:KELLEY, ANNE NAUS (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:NAUS
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MRS
Other - First Name:ANNE
Other - Middle Name:NAUS
Other - Last Name:NAUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:5610 CRAWFORDSVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-3727
Mailing Address - Country:US
Mailing Address - Phone:317-332-1933
Mailing Address - Fax:317-216-1856
Practice Address - Street 1:5610 CRAWFORDSVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-3727
Practice Address - Country:US
Practice Address - Phone:317-332-1933
Practice Address - Fax:317-216-1856
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004046A1041C0700X
IN87000112A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)