Healthcare Provider Details

I. General information

NPI: 1871022483
Provider Name (Legal Business Name): KELLY STUHLDREHER MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W 3RD ST
DOVER OH
44622-2934
US

IV. Provider business mailing address

130 W 3RD ST
DOVER OH
44622-2934
US

V. Phone/Fax

Practice location:
  • Phone: 303-343-6600
  • Fax: 330-343-6600
Mailing address:
  • Phone: 303-343-6600
  • Fax: 330-343-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2001915-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: