Provider Demographics
NPI:1629543624
Name:KELLY, RACHEL (MACP, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:MACP, NCC, LPC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:DIEFENDERFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACP, NCC, LPC
Mailing Address - Street 1:657 S SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:PA
Mailing Address - Zip Code:18014-8862
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3005 BRODHEAD RD STE 28
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-9101
Practice Address - Country:US
Practice Address - Phone:610-602-9252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006405101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional