Provider Demographics
NPI:1730142159
Name:KELLY COUNSELING & CONSULTING, LLC
Entity Type:Organization
Organization Name:KELLY COUNSELING & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:610-358-2250
Mailing Address - Street 1:305 VALLEYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:19017-0534
Mailing Address - Country:US
Mailing Address - Phone:610-358-2250
Mailing Address - Fax:610-358-2251
Practice Address - Street 1:305 VALLEYBROOK RD
Practice Address - Street 2:
Practice Address - City:CHESTER HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:19017-0534
Practice Address - Country:US
Practice Address - Phone:610-358-2250
Practice Address - Fax:610-358-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003436101YP2500X
PAPS005647L103TC0700X
PAPS002719L103TC0700X
PAPS016117103TC0700X
PAPS016001103TC0700X
PACW0148251041C0700X
PAMF000573106H00000X
PAMF000518106H00000X
PAMD065625L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKE1696759OtherBLUE CROSS & BLUE SHIELD
PA056629T4YMedicare PIN
PA119250T4YMedicare PIN
PAKE1696759OtherBLUE CROSS & BLUE SHIELD
PA128421T4YMedicare PIN
PA090008Medicare PIN