Provider Demographics
NPI:1699173518
Name:MCELVAINE, KELLY MARIE (LPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:MCELVAINE
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 1:49 NEDSLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08560-1715
Mailing Address - Country:US
Mailing Address - Phone:732-713-2672
Mailing Address - Fax:
Practice Address - Street 1:49 NEDSLAND AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08560-1715
Practice Address - Country:US
Practice Address - Phone:732-713-2672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00511000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional