Provider Demographics
NPI:1831253095
Name:KELLY, BRITTANY J (MA, CDCA, LPCC, LCDC)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:J
Last Name:KELLY
Suffix:
Gender:
Credentials:MA, CDCA, LPCC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1075
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA STATION
Mailing Address - State:OH
Mailing Address - Zip Code:44028-1075
Mailing Address - Country:US
Mailing Address - Phone:440-529-9419
Mailing Address - Fax:440-588-8764
Practice Address - Street 1:3550 CROCKER RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-6314
Practice Address - Country:US
Practice Address - Phone:440-529-9419
Practice Address - Fax:440-588-8764
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101043101YA0400X
OHE0008042101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0202505Medicaid