Provider Information for 1609173533
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LURETHA KELLY LCSW
Sex: Female
NPI: 1609173533
Last Updated: 2024-08-23
Certification Date: 2024-08-23
Certification Date: 2024-08-23
Details
| Name | Value | ||||||||||||||||
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| NPI | 1609173533 | ||||||||||||||||
| Enumeration Date | 2011-02-11 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 114 STONE CV CLINTON, MS 39056-5020 United States Phone: 601-572-4268 | Fax:601-885-6028 | ||||||||||||||||
| Primary Practice Address | 114 STONE CV CLINTON, MS 39056-5020 United States Phone: 601-572-4268 | Fax:601-885-6028 | ||||||||||||||||
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