Provider Demographics
NPI:1013330505
Name:NEBELSKI, KELLEN (LPCC)
Entity Type:Individual
Prefix:
First Name:KELLEN
Middle Name:
Last Name:NEBELSKI
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 HIGH ST STE A
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1690
Mailing Address - Country:US
Mailing Address - Phone:306-902-3373
Mailing Address - Fax:
Practice Address - Street 1:680 HIGH ST STE A
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1690
Practice Address - Country:US
Practice Address - Phone:330-690-2337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1600028101YP2500X
101Y00000X
OHM.1500025106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist