Provider Demographics
NPI:1003469511
Name:ECHOLS, KELLY J (LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:ECHOLS
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:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866-0153
Mailing Address - Country:US
Mailing Address - Phone:719-238-5800
Mailing Address - Fax:
Practice Address - Street 1:400 W MIDLAND AVE STE 155
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-3196
Practice Address - Country:US
Practice Address - Phone:719-650-8114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15493101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional