Provider Demographics
NPI:1962574954
Name:KELLNER, COLLEEN GAY (LMHC)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:GAY
Last Name:KELLNER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:GAY
Other - Last Name:PICKERING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:45 MERRIMACK ST
Mailing Address - Street 2:CFD
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852
Mailing Address - Country:US
Mailing Address - Phone:978-459-2306
Mailing Address - Fax:978-453-9394
Practice Address - Street 1:45 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-459-2306
Practice Address - Fax:978-453-9394
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health