Provider Demographics
NPI:1306340013
Name:KELLEY HERSHMAN LICENSED MENTAL HEALTH COUNSELOR PLLC
Entity type:Organization
Organization Name:KELLEY HERSHMAN LICENSED MENTAL HEALTH COUNSELOR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:305-720-8855
Mailing Address - Street 1:159 BLEECKER ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1490
Mailing Address - Country:US
Mailing Address - Phone:305-720-8855
Mailing Address - Fax:
Practice Address - Street 1:159 BLEECKER ST APT 2A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1490
Practice Address - Country:US
Practice Address - Phone:305-720-8855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty