Provider Demographics
NPI:1205642097
Name:KIEFER, KELLY (LAPC, NCC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:KIEFER
Suffix:
Gender:F
Credentials:LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 SOUTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-8269
Mailing Address - Country:US
Mailing Address - Phone:717-360-0724
Mailing Address - Fax:
Practice Address - Street 1:2028 LIBERTY RD STE 103
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-5079
Practice Address - Country:US
Practice Address - Phone:443-589-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC000687101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health