Provider Demographics
NPI:1790887693
Name:WORTH, KELLY JO (MS)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JO
Last Name:WORTH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 CLOVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:OH
Mailing Address - Zip Code:43021-9383
Mailing Address - Country:US
Mailing Address - Phone:703-727-4972
Mailing Address - Fax:
Practice Address - Street 1:3645 RIDGE MILL DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7752
Practice Address - Country:US
Practice Address - Phone:614-457-7876
Practice Address - Fax:614-457-7896
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist