Provider Demographics
NPI:1700277316
Name:KELLY PEASON
Entity Type:Organization
Organization Name:KELLY PEASON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:781-389-7643
Mailing Address - Street 1:60 PATTISON ST
Mailing Address - Street 2:27E
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351-1854
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60 PATTISON ST
Practice Address - Street 2:27E
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351-1854
Practice Address - Country:US
Practice Address - Phone:781-389-7643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health