Provider Demographics
NPI:1659193514
Name:COUTTS, KELLY MARIE (MS, LBS)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MARIE
Last Name:COUTTS
Suffix:
Gender:F
Credentials:MS, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-2511
Mailing Address - Country:US
Mailing Address - Phone:267-485-1388
Mailing Address - Fax:
Practice Address - Street 1:630 MONROE AVE
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-2511
Practice Address - Country:US
Practice Address - Phone:267-485-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002979101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health