Provider Demographics
NPI:1225194566
Name:KELLY, HOLLI MARIA (LMFT)
Entity type:Individual
Prefix:DR
First Name:HOLLI
Middle Name:MARIA
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 BALLANTYNE LN NE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55432-1918
Mailing Address - Country:US
Mailing Address - Phone:763-350-3690
Mailing Address - Fax:
Practice Address - Street 1:980 S COBB DR SE BLDG E
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-3300
Practice Address - Country:US
Practice Address - Phone:763-350-3690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
MN1129106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist