1467840504 NPI number — MRS. KELLEY OWUSU ASANTE LPC

Table of content: MRS. KELLEY OWUSU ASANTE LPC (NPI 1467840504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467840504 NPI number — MRS. KELLEY OWUSU ASANTE LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASANTE
Provider First Name:
KELLEY
Provider Middle Name:
OWUSU
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALL
Provider Other First Name:
KELLEY
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC, BC-TMH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467840504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 RACCOON TRCE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35806-4021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-684-1700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 RACCOON TRCE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35806-4021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-684-1700
Provider Business Practice Location Address Fax Number:
888-439-5222
Provider Enumeration Date:
12/23/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  3672 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1467840504 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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