Provider Demographics
NPI:1427772532
Name:KELLY, CATHERINE ANN (LPC, ATR)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:KELLY
Suffix:
Gender:F
Credentials:LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31W755 ARMY TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:IL
Mailing Address - Zip Code:60184-2153
Mailing Address - Country:US
Mailing Address - Phone:630-849-1398
Mailing Address - Fax:
Practice Address - Street 1:478 PENNSYLVANIA AVE STE 302
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-4425
Practice Address - Country:US
Practice Address - Phone:708-274-7289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178014982101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health