Provider Demographics
NPI:1528520046
Name:KELLEY, MEGAN (LPC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N JOHNSTON AVE STE A206
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08609-1806
Mailing Address - Country:US
Mailing Address - Phone:609-503-4562
Mailing Address - Fax:
Practice Address - Street 1:1 N JOHNSTON AVE STE A206
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08609-1806
Practice Address - Country:US
Practice Address - Phone:609-503-4562
Practice Address - Fax:609-939-2973
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00653400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health