Provider Demographics
NPI:1871669093
Name:KELAHAN, BETTY A (LPC)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:A
Last Name:KELAHAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:KELAHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:621 NORTH AVE NE STE E100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2865
Mailing Address - Country:US
Mailing Address - Phone:404-825-2875
Mailing Address - Fax:770-507-5551
Practice Address - Street 1:621 NORTH AVE NE STE E100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2865
Practice Address - Country:US
Practice Address - Phone:404-825-2875
Practice Address - Fax:770-507-5551
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002990101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional