Healthcare Provider Details

I. General information

NPI: 1790887693
Provider Name (Legal Business Name): KELLY JO WORTH M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 GRAPHICS WAY STE 3100
LEWIS CENTER OH
43035-0238
US

IV. Provider business mailing address

5770 CLOVERDALE DR
GALENA OH
43021-9383
US

V. Phone/Fax

Practice location:
  • Phone: 740-428-0428
  • Fax: 740-909-4077
Mailing address:
  • Phone: 703-727-4972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberF.1900096
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: