Provider Demographics
NPI:1235408618
Name:LAPORTE, KELLY (MA, LPC, CADC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:LAPORTE
Suffix:
Gender:F
Credentials:MA, LPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MAIN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4059
Mailing Address - Country:US
Mailing Address - Phone:708-601-1185
Mailing Address - Fax:888-440-2577
Practice Address - Street 1:36 MAIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4059
Practice Address - Country:US
Practice Address - Phone:708-601-1185
Practice Address - Fax:888-440-2577
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.007762101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional