Healthcare Provider Details

I. General information

NPI: 1033048707
Provider Name (Legal Business Name): KELLY POLLOCK COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CREEKSIDE LN
FISHERS IN
46038-1119
US

IV. Provider business mailing address

109 CREEKSIDE LN
FISHERS IN
46038-1119
US

V. Phone/Fax

Practice location:
  • Phone: 765-376-9907
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KELLY POLLOCK
Title or Position: OWNER
Credential: MA, LMHC
Phone: 765-376-9907