Healthcare Provider Details

I. General information

NPI: 1609240639
Provider Name (Legal Business Name): JOSEPH LAWRENCE KELLY LPC,CPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 THOMAS JONES WAY STE 204
EXTON PA
19341-2553
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7725
US

V. Phone/Fax

Practice location:
  • Phone: 866-452-2816
  • Fax: 484-468-1412
Mailing address:
  • Phone: 866-452-2816
  • Fax: 484-468-1412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC008422
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: