Provider Demographics
NPI:1396496659
Name:STEPHENS, KELLI ANN (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:ANN
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 BANYAN BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-4102
Mailing Address - Country:US
Mailing Address - Phone:606-599-6576
Mailing Address - Fax:
Practice Address - Street 1:256 BANYAN BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-4102
Practice Address - Country:US
Practice Address - Phone:606-599-6576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2593161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty