Provider Demographics
NPI:1790294726
Name:BEESE, KELLYN (LPCC)
Entity type:Individual
Prefix:
First Name:KELLYN
Middle Name:
Last Name:BEESE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:KELLYN
Other - Middle Name:
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23550 CENTER RIDGE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-3655
Mailing Address - Country:US
Mailing Address - Phone:440-732-5252
Mailing Address - Fax:440-271-2003
Practice Address - Street 1:23550 CENTER RIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-3655
Practice Address - Country:US
Practice Address - Phone:440-732-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C.1700505101YP2500X, 104100000X
OHE.2404762101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker