Provider Demographics
NPI:1255714291
Name:KELL, MARK (LPC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:KELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N VERMONT ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2833
Mailing Address - Country:US
Mailing Address - Phone:985-246-9138
Mailing Address - Fax:
Practice Address - Street 1:321 N VERMONT ST
Practice Address - Street 2:SUITE 203
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2833
Practice Address - Country:US
Practice Address - Phone:985-246-9138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5241101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health