Provider Demographics
NPI:1922165398
Name:PIKE, KELLY M (MED LMHC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:M
Last Name:PIKE
Suffix:
Gender:F
Credentials:MED LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 KENNEDY TERRACE
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-790-0811
Mailing Address - Fax:
Practice Address - Street 1:275 MILLWAY
Practice Address - Street 2:
Practice Address - City:BARNSTABLE
Practice Address - State:MA
Practice Address - Zip Code:02630-1102
Practice Address - Country:US
Practice Address - Phone:508-517-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6137101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health