Provider Demographics
NPI:1184458994
Name:CONNER, KELLY LEIGH (LPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LEIGH
Last Name:CONNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 DOC WELKER RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:PA
Mailing Address - Zip Code:16881-8609
Mailing Address - Country:US
Mailing Address - Phone:814-553-4989
Mailing Address - Fax:
Practice Address - Street 1:1633 PHILIPSBURG BIGLER HWY
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-8112
Practice Address - Country:US
Practice Address - Phone:814-342-5845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017466101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional