Provider Demographics
NPI:1215814017
Name:ULLMAN, KELLY BATES (LPCC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:BATES
Last Name:ULLMAN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 ANTARES AVE
Mailing Address - Street 2:SUITE B1
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240
Mailing Address - Country:US
Mailing Address - Phone:614-505-0091
Mailing Address - Fax:614-505-0077
Practice Address - Street 1:9030 ANTARES AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240
Practice Address - Country:US
Practice Address - Phone:614-505-0091
Practice Address - Fax:614-505-0077
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2505125101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)