Provider Demographics
NPI:1255739504
Name:KELVINGTON, PAUL ANDREW (LCSW,LCPC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDREW
Last Name:KELVINGTON
Suffix:
Gender:M
Credentials:LCSW,LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 1/2 W OAKDALE AVE
Mailing Address - Street 2:#1W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5370
Mailing Address - Country:US
Mailing Address - Phone:773-666-3022
Mailing Address - Fax:
Practice Address - Street 1:654 1/2 W OAKDALE AVE
Practice Address - Street 2:#1W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5370
Practice Address - Country:US
Practice Address - Phone:773-666-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009378101YP2500X
IL149.0155921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional