Provider Demographics
NPI:1902900699
Name:GONZALEZ, KELLY H (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:H
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:L
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5641
Practice Address - Country:US
Practice Address - Phone:912-435-5313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000004347104100000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
4117927OtherMAGELLAN NAVIGATOR
620582605OtherINTIAL GROUP GROUP
620582605OtherTHREE RIVERS PROVI GROUP
334969OtherVALUE OPTIONS GROUP
4117927OtherMAGELLAN SUMMIT
4117927OtherMAGELLAN PINNACLE