Provider Demographics
NPI:1831223205
Name:KELLY, MARGARET (LCPC)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3759 W 95TH ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2000
Mailing Address - Country:US
Mailing Address - Phone:708-535-2777
Mailing Address - Fax:773-233-1440
Practice Address - Street 1:3759 W 95TH ST
Practice Address - Street 2:SUITE #3
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2000
Practice Address - Country:US
Practice Address - Phone:708-535-2777
Practice Address - Fax:773-233-1440
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional