Provider Demographics
NPI:1538643549
Name:OCONNELL, KELLY JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:OCONNELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-5522
Mailing Address - Country:US
Mailing Address - Phone:412-583-9791
Mailing Address - Fax:
Practice Address - Street 1:9401 MCKNIGHT RD STE 105
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-6000
Practice Address - Country:US
Practice Address - Phone:412-367-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010317101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional