Provider Demographics
NPI:1558794511
Name:KELLY, CAROLINE E (LPCC-S)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:E
Last Name:KELLY
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:E
Other - Last Name:BONTRAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:513 WASHBURN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4725
Mailing Address - Country:US
Mailing Address - Phone:574-309-1835
Mailing Address - Fax:
Practice Address - Street 1:135 CHENOWETH LN STE 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2603
Practice Address - Country:US
Practice Address - Phone:502-309-9565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171717101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor