Provider Demographics
NPI:1376051771
Name:OZELSKI, KELLY LEE (LMFT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LEE
Last Name:OZELSKI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 S 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-2559
Mailing Address - Country:US
Mailing Address - Phone:717-926-6760
Mailing Address - Fax:
Practice Address - Street 1:752 WILLOW ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-5066
Practice Address - Country:US
Practice Address - Phone:717-926-6760
Practice Address - Fax:877-250-4210
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000948106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist