Provider Demographics
NPI:1235745209
Name:FREY, KELLI ANN (LPC, NCC, CADC)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:ANN
Last Name:FREY
Suffix:
Gender:F
Credentials:LPC, NCC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 LENORE PL
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1223
Mailing Address - Country:US
Mailing Address - Phone:610-790-5342
Mailing Address - Fax:
Practice Address - Street 1:523 LENORE PL
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19609-1223
Practice Address - Country:US
Practice Address - Phone:610-790-5342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA265839101Y00000X
PAPC006948101YP2500X
PA9397101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty