Provider Demographics
NPI:1780088856
Name:FEEHELY, KELLY L
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:FEEHELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6117 TWILIGHT CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-2270
Mailing Address - Country:US
Mailing Address - Phone:443-986-0032
Mailing Address - Fax:
Practice Address - Street 1:305 W CHESAPEAKE AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-4421
Practice Address - Country:US
Practice Address - Phone:443-986-0032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5403101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional