Provider Demographics
NPI:1134840499
Name:KELLY GROVER COUNSELING LLC
Entity type:Organization
Organization Name:KELLY GROVER COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:419-377-6316
Mailing Address - Street 1:4450 CARVER WOODS DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5528
Mailing Address - Country:US
Mailing Address - Phone:513-984-9940
Mailing Address - Fax:513-984-9858
Practice Address - Street 1:4450 CARVER WOODS DR STE 2
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-5528
Practice Address - Country:US
Practice Address - Phone:513-984-9940
Practice Address - Fax:513-984-9858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty