Provider Demographics
NPI:1235905175
Name:KELLEY, KATIE MARIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:LEECHBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15656-1530
Mailing Address - Country:US
Mailing Address - Phone:724-487-9900
Mailing Address - Fax:
Practice Address - Street 1:420 SUNRISE DR
Practice Address - Street 2:
Practice Address - City:LEECHBURG
Practice Address - State:PA
Practice Address - Zip Code:15656-1530
Practice Address - Country:US
Practice Address - Phone:724-487-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional