Individual
MARY L KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
682 WASHINGTON ST, BATH, ME 04530
(207) 442-0682
(707) 442-0680
Mailing address
1090 POST RD, BOWDOINHAM, ME 04008
(207) 737-9001
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CC2124
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
098941
ANTHEM
—
Enumeration date
05/18/2007
Last updated
07/09/2007
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