Provider Demographics
NPI:1235604745
Name:WOOD, KELLEY LOUISE (LPC)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:LOUISE
Last Name:WOOD
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 1:1318 WOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHELOCTA
Mailing Address - State:PA
Mailing Address - Zip Code:15774-7200
Mailing Address - Country:US
Mailing Address - Phone:412-398-9771
Mailing Address - Fax:
Practice Address - Street 1:4232 NORTHERN PIKE STE 201
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2720
Practice Address - Country:US
Practice Address - Phone:412-663-0062
Practice Address - Fax:412-202-1705
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010682101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional