Provider Demographics
NPI:1023983525
Name:KELLY, INGRID M (LMSW)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:M
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 SOUTHWOOD CV SW UNIT 521
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5891
Mailing Address - Country:US
Mailing Address - Phone:504-858-8924
Mailing Address - Fax:
Practice Address - Street 1:627 OPELOUSAS AVE # 17
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-4343
Practice Address - Country:US
Practice Address - Phone:504-688-9323
Practice Address - Fax:608-740-5963
Is Sole Proprietor?:No
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15088106S00000X, 171M00000X, 1041S0200X, 172V00000X, 174H00000X, 251B00000X, 251S00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health