| Cassy Kelly, Llc | |
|
7221 W 79th St Ste 105 Overland Park KS 66204-2906 | |
| (913) 444-0083 | |
| Not Available |
| Full Name | Cassy Kelly, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7221 W 79th St Ste 105, Overland Park, Kansas |
| Authorized Official Name and Position | Stacey M Deister (CREDENTIALER) |
| Authorized Official Contact | 8163654070 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cassy Kelly, Llc 7221 W 79th St Ste 105 Overland Park KS 66204-2906 Ph: (913) 444-0083 | Cassy Kelly, Llc 7221 W 79th St Ste 105 Overland Park KS 66204-2906 Ph: (913) 444-0083 |
| NPI Number | 1285369371 |
|---|---|
| Provider Enumeration Date | 07/21/2022 |
| Last Update Date | 08/09/2022 |
| Certification Date | 08/09/2022 |
| Medicare PECOS PAC ID | 6709260649 |
|---|---|
| Medicare Enrollment ID | O20220826001407 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285369371 | NPI | - | NPPES |
| 30004819650001 | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Casandra Kelly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255646105 PECOS PAC ID: 2062896905 Enrollment ID: I20220826001501 |
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