Individual
MARC KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
321 E MAIN ST, MOREHEAD, KY 40351-1671
(606) 784-4161
(606) 783-9952
Mailing address
PO BOX 790, ASHLAND, KY 41105-0790
(606) 329-8588
(606) 329-8195
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
252084
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000603438
ANTHEM BCBS
—
05
—
7100419780
—
KY
Enumeration date
10/12/2006
Last updated
06/13/2017
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