Provider Demographics
NPI:1376074203
Name:KELLY, LISA
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:CHATTERLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:693 VALLEY TERRACE, UNIT B
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:KY
Mailing Address - Zip Code:41076
Mailing Address - Country:US
Mailing Address - Phone:870-403-6443
Mailing Address - Fax:
Practice Address - Street 1:693 VALLEY TERRACE, UNIT B
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076
Practice Address - Country:US
Practice Address - Phone:870-403-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker