Provider Demographics
NPI:1528881976
Name:KELLEY, JENNIFER LEE (MA, LPCC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 47TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55428-4507
Mailing Address - Country:US
Mailing Address - Phone:612-242-9338
Mailing Address - Fax:
Practice Address - Street 1:8441 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1344
Practice Address - Country:US
Practice Address - Phone:962-835-6540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4593101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health