Provider Demographics
NPI:1609479583
Name:MCNELLIS, KATELYN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:
Last Name:MCNELLIS
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 1:10509 JACOB DR
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-9373
Mailing Address - Country:US
Mailing Address - Phone:708-955-9563
Mailing Address - Fax:
Practice Address - Street 1:3711 N RAVENSWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3599
Practice Address - Country:US
Practice Address - Phone:773-274-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional