Provider Demographics
NPI:1720855414
Name:KELLEY MASSENGALE, LCSW, LLC
Entity Type:Organization
Organization Name:KELLEY MASSENGALE, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSENGALE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-246-2359
Mailing Address - Street 1:3428 LIME ST
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6340
Mailing Address - Country:US
Mailing Address - Phone:225-326-9490
Mailing Address - Fax:
Practice Address - Street 1:3428 LIME ST
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35242-6340
Practice Address - Country:US
Practice Address - Phone:225-326-9490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty