Healthcare Provider Details

I. General information

NPI: 1154246064
Provider Name (Legal Business Name): KELLY HAINES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 SWEDE RD STE 212
BLUE BELL PA
19422-3372
US

IV. Provider business mailing address

271 PARK AVE
HARLEYSVILLE PA
19438-1854
US

V. Phone/Fax

Practice location:
  • Phone: 267-419-7878
  • Fax:
Mailing address:
  • Phone:
  • Fax: 610-937-6138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC020810
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: