Provider Demographics
NPI:1225700347
Name:FOX, KELLY ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:FOX
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 1:1160 MUNICIPAL DR APT 17
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-8075
Mailing Address - Country:US
Mailing Address - Phone:814-571-9120
Mailing Address - Fax:
Practice Address - Street 1:3941 S ATHERTON ST STE A
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-8309
Practice Address - Country:US
Practice Address - Phone:814-753-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012218101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health