Provider Demographics
NPI:1255062154
Name:CASH, KELLY MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:CASH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9378 GERMAN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:IN
Mailing Address - Zip Code:47525-9526
Mailing Address - Country:US
Mailing Address - Phone:812-719-9418
Mailing Address - Fax:
Practice Address - Street 1:9378 GERMAN RIDGE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:IN
Practice Address - Zip Code:47525-9526
Practice Address - Country:US
Practice Address - Phone:812-719-9418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3400596A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health