Provider Demographics
NPI:1386818086
Name:KELLING, RICHARD (MSED)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:KELLING
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SPINNING WHEEL RD.
Mailing Address - Street 2:PO BOX 17180
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172
Mailing Address - Country:US
Mailing Address - Phone:630-924-0156
Mailing Address - Fax:
Practice Address - Street 1:15 SPINNING WHEEL RD
Practice Address - Street 2:STE. #420
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2914
Practice Address - Country:US
Practice Address - Phone:630-325-8252
Practice Address - Fax:630-325-7584
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02220332OtherBC/BS OF IL