Healthcare Provider Details

I. General information

NPI: 1912676545
Provider Name (Legal Business Name): KELLY AKEHURST LPC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 HIGH RIDGE RD STE 137
STAMFORD CT
06905-1221
US

IV. Provider business mailing address

431 DURHAM RD
MADISON CT
06443-2041
US

V. Phone/Fax

Practice location:
  • Phone: 475-477-0278
  • Fax:
Mailing address:
  • Phone: 475-477-0248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KELLY AKEHURST
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: MA
Phone: 475-477-0278