Healthcare Provider Details

I. General information

NPI: 1588179550
Provider Name (Legal Business Name): KELLEY M BECKETT LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MESSIMER DR
NEWARK OH
43055-1874
US

IV. Provider business mailing address

2174 KELLEY LN
NEWARK OH
43055-8057
US

V. Phone/Fax

Practice location:
  • Phone: 740-458-7800
  • Fax:
Mailing address:
  • Phone: 740-641-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2505826
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: