Provider Demographics
NPI:1801384284
Name:KELLY, HEATHER CHRISTINE (LCSW, LPHA)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:CHRISTINE
Last Name:KELLY
Suffix:
Gender:F
Credentials:LCSW, LPHA
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:CHRISTINE
Other - Last Name:HUTTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1302 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-2430
Mailing Address - Country:US
Mailing Address - Phone:217-549-7559
Mailing Address - Fax:
Practice Address - Street 1:1901 S 4TH ST STE 213
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-4188
Practice Address - Country:US
Practice Address - Phone:217-347-5880
Practice Address - Fax:217-347-5897
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical