Provider Demographics
NPI:1972049450
Name:PICKERING, KELLY JEAN (LPC, CMHC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:PICKERING
Suffix:
Gender:
Credentials:LPC, CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2330
Mailing Address - Country:US
Mailing Address - Phone:785-273-2252
Mailing Address - Fax:785-273-7489
Practice Address - Street 1:330 SW OAKLEY AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1995
Practice Address - Country:US
Practice Address - Phone:785-273-2252
Practice Address - Fax:785-273-7489
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03707101YP2500X
UT11739145-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional