| Doctor Name: | MRS. KELLY KUBALA MEHAN |
| NPI Number: | 1376740829 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.C.S.W |
| License Number: | 2006018306 |
| Business Practice Address: | 408 Jefferson Street St. Charles, MO - 63301 |
| Business Phone Number: | 3144405800 |
| Business Fax Number: | |
| Mailing Address: | 5854 Walsh St, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631093120 |
| Phone Number: | 3144405800 |
| Fax Number: | |
| NPI Enumeration Date: | 06/28/2007 |
| NPI Last Update Date: | 10/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 2006018306 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |