Provider Demographics
NPI:1265082473
Name:KELLEY, KARISSA (LPC, CT)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LPC, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 LANTERN LN
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-3299
Mailing Address - Country:US
Mailing Address - Phone:267-469-0694
Mailing Address - Fax:215-689-1533
Practice Address - Street 1:352 LANTERN LN
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-3299
Practice Address - Country:US
Practice Address - Phone:267-469-0694
Practice Address - Fax:215-689-1533
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009412101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional