Provider Demographics
NPI:1720507692
Name:IRVING, KELSEY (LPC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:IRVING
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:REDDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8870 TOWANDA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3628
Mailing Address - Country:US
Mailing Address - Phone:201-675-9456
Mailing Address - Fax:
Practice Address - Street 1:8870 TOWANDA ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3628
Practice Address - Country:US
Practice Address - Phone:201-675-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PAPC011637101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1194889782OtherNPI