Provider Demographics
NPI:1831565746
Name:CHRISTIAN, KELLY (MA, LMHC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 VILLAGE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3756
Mailing Address - Country:US
Mailing Address - Phone:781-789-5567
Mailing Address - Fax:
Practice Address - Street 1:20 VILLAGE ST APT 2
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-3756
Practice Address - Country:US
Practice Address - Phone:781-789-5567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health