Healthcare Provider Details

I. General information

NPI: 1265663132
Provider Name (Legal Business Name): KELLY L JONES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 GRANT ST
SEWICKLEY PA
15143-1231
US

IV. Provider business mailing address

414 GRANT ST
SEWICKLEY PA
15143-1231
US

V. Phone/Fax

Practice location:
  • Phone: 412-741-7430
  • Fax: 412-741-7430
Mailing address:
  • Phone: 412-741-7430
  • Fax: 412-741-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE0008020
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC005667
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: