Provider Demographics
NPI:1619071073
Name:KAPLAN, KELLY G (LPC, SAP)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:G
Last Name:KAPLAN
Suffix:
Gender:F
Credentials:LPC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 PIERCE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2821
Mailing Address - Country:US
Mailing Address - Phone:478-742-1464
Mailing Address - Fax:478-742-1883
Practice Address - Street 1:179 PIERCE AVENUE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204
Practice Address - Country:US
Practice Address - Phone:478-742-1464
Practice Address - Fax:478-742-1883
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002555101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA920282809AMedicaid