Provider Demographics
NPI:1750772380
Name:KELLEY, WHITLEE LAINA (BS)
Entity type:Individual
Prefix:
First Name:WHITLEE
Middle Name:LAINA
Last Name:KELLEY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 TITAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630
Mailing Address - Country:US
Mailing Address - Phone:256-275-7089
Mailing Address - Fax:256-341-0747
Practice Address - Street 1:112 TITAN DRIVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630
Practice Address - Country:US
Practice Address - Phone:256-275-7089
Practice Address - Fax:256-341-0747
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2019-04-24
Deactivation Date:2018-03-10
Deactivation Code:
Reactivation Date:2019-04-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator