Provider Demographics
NPI:1467753202
Name:MCBEAN, KELLY C (LCPC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:C
Last Name:MCBEAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8350
Mailing Address - Country:US
Mailing Address - Phone:815-385-6400
Mailing Address - Fax:815-385-8127
Practice Address - Street 1:4100 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8350
Practice Address - Country:US
Practice Address - Phone:815-385-6400
Practice Address - Fax:815-385-8127
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007448101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional