Provider Demographics
NPI:1184046518
Name:KELLEY, BRITNI (MA)
Entity type:Individual
Prefix:
First Name:BRITNI
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:BRITNI
Other - Middle Name:
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:821 RAYMOND AVE STE 325
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-5002
Mailing Address - Country:US
Mailing Address - Phone:612-293-8052
Mailing Address - Fax:651-925-0517
Practice Address - Street 1:821 RAYMOND AVE STE 325
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114
Practice Address - Country:US
Practice Address - Phone:612-293-8052
Practice Address - Fax:651-925-0517
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3453106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist