Provider Demographics
NPI:1992334361
Name:KELLY, LORIN C (MA)
Entity type:Individual
Prefix:
First Name:LORIN
Middle Name:C
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 CALVERT ST
Mailing Address - Street 2:#22013
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-2131
Mailing Address - Country:US
Mailing Address - Phone:785-465-4961
Mailing Address - Fax:
Practice Address - Street 1:1201 CALVERT ST
Practice Address - Street 2:#22013
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-2131
Practice Address - Country:US
Practice Address - Phone:785-465-4961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KS3050101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health