Provider Demographics
NPI:1912123449
Name:MCNICHOLS, KELLEY BETH (MSED, LPC, CAC, CCDP)
Entity Type:Individual
Prefix:MISS
First Name:KELLEY
Middle Name:BETH
Last Name:MCNICHOLS
Suffix:
Gender:F
Credentials:MSED, LPC, CAC, CCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-2932
Mailing Address - Country:US
Mailing Address - Phone:724-994-9221
Mailing Address - Fax:412-244-4550
Practice Address - Street 1:355 5TH AVE
Practice Address - Street 2:PARK BUILDING, SUITE 410
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-2409
Practice Address - Country:US
Practice Address - Phone:412-244-4550
Practice Address - Fax:412-244-4550
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)