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NPI Code Detail

MEDICARE: KELLY MACKEY LPC

MEDICARE: KELLY MACKEY LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorC.2305622OH

General Provider Information

NPI Number : 1023609054
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY MACKEY LPC
Provider Business Mailing Address
First Line : 3518 W 25TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1951
Country : US
Telephone Number : 216-741-2241
Fax Number : 216-739-3638
Provider Business Practice Location Address
First Line : 3518 W 25TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1951
Country : US
Telephone Number : 216-741-2241
Fax Number : 216-739-3638
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2021
Last Update Date : 03/02/2026

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Directions to “ KELLY MACKEY LPC” Practice Location

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