Healthcare Provider Details

I. General information

NPI: 1386559672
Provider Name (Legal Business Name): STEPHANIE MCKELVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 GIBSON ST
YOUNGSTOWN OH
44502-2305
US

IV. Provider business mailing address

343 MANSELL DR
YOUNGSTOWN OH
44505-1962
US

V. Phone/Fax

Practice location:
  • Phone: 330-744-8002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.01690
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: