Provider Demographics
NPI:1487829537
Name:KELLEY, DENISE E (MSED LPC NCC BCBA)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:E
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MSED LPC NCC BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3457
Mailing Address - Country:US
Mailing Address - Phone:330-543-8590
Mailing Address - Fax:330-543-3856
Practice Address - Street 1:3679 STATE ST
Practice Address - Street 2:STE G
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148
Practice Address - Country:US
Practice Address - Phone:330-502-2499
Practice Address - Fax:724-982-4407
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0800108101YP2500X
PAPC004805101YP2500X
PA1-10-7774103K00000X
OHE.0800108101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst