Provider Demographics
NPI:1336165398
Name:KOCHELL, KELLY BRIAN (LCSW, LMFT)
Entity Type:Individual
Prefix:MR
First Name:KELLY
Middle Name:BRIAN
Last Name:KOCHELL
Suffix:
Gender:M
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9292 N MERIDIAN ST STE 311
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1828
Mailing Address - Country:US
Mailing Address - Phone:317-466-8833
Mailing Address - Fax:317-255-7854
Practice Address - Street 1:9292 N MERIDIAN ST STE 311
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1828
Practice Address - Country:US
Practice Address - Phone:317-466-8833
Practice Address - Fax:317-255-7854
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002771A1041C0700X
IN35000120A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist