Provider Demographics
NPI:1831703131
Name:KELLY, COLLEEN ELIZABETH (MA, LCPC, CADC)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ELIZABETH
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA, LCPC, CADC
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:ELIZABETH
Other - Last Name:MERTENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LCPC, CADC
Mailing Address - Street 1:225 N MICHIGAN AVE STE 1430
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7653
Mailing Address - Country:US
Mailing Address - Phone:312-766-6780
Mailing Address - Fax:
Practice Address - Street 1:225 N MICHIGAN AVE STE 1430
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7653
Practice Address - Country:US
Practice Address - Phone:312-766-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL33101101YA0400X
IL180014764101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)