Provider Demographics
NPI:1912676545
Name:KELLY AKEHURST LPC LLC
Entity Type:Organization
Organization Name:KELLY AKEHURST LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:AKEHURST
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:475-477-0278
Mailing Address - Street 1:46 PEQUOT LN
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-2020
Mailing Address - Country:US
Mailing Address - Phone:475-477-0248
Mailing Address - Fax:
Practice Address - Street 1:270 GREENWICH AVE STE 19
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6530
Practice Address - Country:US
Practice Address - Phone:475-477-0278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health