Provider Demographics
NPI:1932519089
Name:KELLEY, DEVERIE ANN (LCSW, LAC)
Entity Type:Individual
Prefix:
First Name:DEVERIE
Middle Name:ANN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 11TH AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4808
Mailing Address - Country:US
Mailing Address - Phone:406-603-4151
Mailing Address - Fax:406-442-0248
Practice Address - Street 1:2001 11TH AVE STE 6
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4808
Practice Address - Country:US
Practice Address - Phone:406-603-4151
Practice Address - Fax:406-442-0248
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-3377101YA0400X
MTBBH-LCSW-LIC-305531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)