Provider Demographics
NPI:1649914201
Name:JUNEAU, KELLY LYNN (MSW, LMSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:JUNEAU
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 PICONE DR
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-4452
Mailing Address - Country:US
Mailing Address - Phone:504-377-7858
Mailing Address - Fax:
Practice Address - Street 1:1525 RIVER OAKS RD W
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-2199
Practice Address - Country:US
Practice Address - Phone:504-734-1740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health