Healthcare Provider Details

I. General information

NPI: 1437514502
Provider Name (Legal Business Name): KELLY M REPAS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 CARNEGIE AVE
CLEVELAND OH
44115-2641
US

IV. Provider business mailing address

202 E BAGLEY RD
BEREA OH
44017-2058
US

V. Phone/Fax

Practice location:
  • Phone: 440-260-8327
  • Fax: 440-234-8319
Mailing address:
  • Phone: 440-260-8327
  • Fax: 440-260-8576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.0900036
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0900036
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: