Provider Demographics
NPI:1306904008
Name:WILLIAMS, KELLY KAY (LPC)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:KAY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5562 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-6012
Mailing Address - Country:US
Mailing Address - Phone:417-448-4148
Mailing Address - Fax:417-347-7772
Practice Address - Street 1:3404 SHIFFERDECKER
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64802
Practice Address - Country:US
Practice Address - Phone:417-237-7773
Practice Address - Fax:417-347-7772
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002676101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health