| Doctor Name: | MARY LOU KELLEY |
| NPI Number: | 1003943937 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 519 |
| Business Practice Address: | 7936 Wrenwood Blvd Ste B Baton Rouge, LA - 708097701 |
| Business Phone Number: | 2259252036 |
| Business Fax Number: | |
| Mailing Address: | 7936 Wrenwood Blvd Ste B, BATON ROUGE |
| State: | LA |
| Postal Code: | 708097701 |
| Phone Number: | 2259252036 |
| Fax Number: | |
| NPI Enumeration Date: | 02/27/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 519 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |