Individual
MARY T KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
719 E 17TH ST, CHEYENNE, WY 82001-4711
(307) 509-0772
(307) 426-4133
Mailing address
719 E 17TH ST, CHEYENNE, WY 82001-4711
(307) 509-0772
(307) 369-2370
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
366
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106079100
—
WY
Enumeration date
01/15/2010
Last updated
04/14/2017
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