Provider Demographics
NPI:1790294726
Name:BEESE, KELLYN (LPC)
Entity Type:Individual
Prefix:
First Name:KELLYN
Middle Name:
Last Name:BEESE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KELLYN
Other - Middle Name:
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29133 HEALTH CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5256
Mailing Address - Country:US
Mailing Address - Phone:440-835-6212
Mailing Address - Fax:440-899-4396
Practice Address - Street 1:3401 ENTERPRISE PKWY STE 250
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7343
Practice Address - Country:US
Practice Address - Phone:866-237-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C.1700505104100000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker