Provider Demographics
NPI:1215274675
Name:KELLY, ALYSSA MARIE (LIMFT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARIE
Last Name:KELLY
Suffix:
Gender:
Credentials:LIMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 N FORGE ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1317
Mailing Address - Country:US
Mailing Address - Phone:330-762-0591
Mailing Address - Fax:
Practice Address - Street 1:18 N FORGE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1317
Practice Address - Country:US
Practice Address - Phone:330-762-0591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X
OHF.2100193106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No376J00000XNursing Service Related ProvidersHomemaker