Provider Demographics
NPI:1891033098
Name:KELL, SHAUN PATRICK (LMFT)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:PATRICK
Last Name:KELL
Suffix:
Gender:M
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:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-0818
Mailing Address - Country:US
Mailing Address - Phone:478-227-9430
Mailing Address - Fax:
Practice Address - Street 1:111 DOLLY ST
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-5307
Practice Address - Country:US
Practice Address - Phone:478-227-9430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001131106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist