Provider Demographics
NPI:1982310231
Name:CHRISTIE KELLY LICENSED PROFESSIONAL COUNSELING LLC
Entity type:Organization
Organization Name:CHRISTIE KELLY LICENSED PROFESSIONAL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-730-2599
Mailing Address - Street 1:1 WILLIAMS PLACE
Mailing Address - Street 2:SUITE G2
Mailing Address - City:WARRENDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15086
Mailing Address - Country:US
Mailing Address - Phone:814-730-2599
Mailing Address - Fax:
Practice Address - Street 1:1 WILLIAMS PLACE
Practice Address - Street 2:SUITE G2
Practice Address - City:WARRENDALE
Practice Address - State:PA
Practice Address - Zip Code:15086
Practice Address - Country:US
Practice Address - Phone:814-730-2599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty