| Doctor Name: | MARY L KELLEY |
| NPI Number: | 1114973369 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 1203 |
| Business Practice Address: | 503 Centre View Blvd Crestview Hills, KY - 410173444 |
| Business Phone Number: | 8594267800 |
| Business Fax Number: | 8594267804 |
| Mailing Address: | Po Box 17277, COVINGTON |
| State: | KY |
| Postal Code: | 410170277 |
| Phone Number: | 8594267800 |
| Fax Number: | 8594267804 |
| NPI Enumeration Date: | 05/26/2006 |
| NPI Last Update Date: | 05/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 1203 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |