Provider Demographics
NPI:1689285744
Name:MEEK, KELLY ANN-CLARK (MA, NCC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN-CLARK
Last Name:MEEK
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, NCC
Mailing Address - Street 1:224 WOOD RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18844-7402
Mailing Address - Country:US
Mailing Address - Phone:570-396-3936
Mailing Address - Fax:
Practice Address - Street 1:102 N ABINGTON RD STE 107
Practice Address - Street 2:
Practice Address - City:CLARKS GREEN
Practice Address - State:PA
Practice Address - Zip Code:18411-2300
Practice Address - Country:US
Practice Address - Phone:570-536-0039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor