Provider Demographics
NPI:1255524229
Name:SHIVELY, KELLY LORRAINE (LPC)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:LORRAINE
Last Name:SHIVELY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1738 S MARTINSON
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-5799
Mailing Address - Country:US
Mailing Address - Phone:316-293-9547
Mailing Address - Fax:316-691-8473
Practice Address - Street 1:1738 S MARTINSON
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-5799
Practice Address - Country:US
Practice Address - Phone:316-293-9547
Practice Address - Fax:316-691-8473
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1942101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional