Provider Demographics
NPI:1912719386
Name:KELLEY, BRIAN MATTHEW (LCDC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MATTHEW
Last Name:KELLEY
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 NORTH LOOP E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77028-5951
Mailing Address - Country:US
Mailing Address - Phone:346-578-2273
Mailing Address - Fax:
Practice Address - Street 1:7200 NORTH LOOP E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77028-5951
Practice Address - Country:US
Practice Address - Phone:346-578-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15944101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)