Provider Demographics
NPI:1689146193
Name:SHOPE, KELLY (MA,LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SHOPE
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:882 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLINVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08322-2823
Mailing Address - Country:US
Mailing Address - Phone:856-516-4933
Mailing Address - Fax:
Practice Address - Street 1:875 KINGS HWY STE 100
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3165
Practice Address - Country:US
Practice Address - Phone:856-251-0500
Practice Address - Fax:856-797-4785
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00215500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional