Individual
LURETHA KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
114 STONE CV, CLINTON, MS 39056-5020
(601) 572-4268
(601) 885-6028
Mailing address
114 STONE CV, CLINTON, MS 39056-5020
(601) 572-4268
(601) 885-6028
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C6936
MS
104100000X
Social Worker
M6936
MS
1041C0700X
Clinical Social Worker
C6936
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08434862
—
MS
Enumeration date
02/11/2011
Last updated
08/23/2024
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