Healthcare Provider Details

I. General information

NPI: 1023644101
Provider Name (Legal Business Name): LAUREN KELLY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E LANCASTER AVE UNIT 130D
ST DAVIDS PA
19087-5032
US

IV. Provider business mailing address

1401 S 31ST ST FL 2
PHILADELPHIA PA
19146-3506
US

V. Phone/Fax

Practice location:
  • Phone: 215-272-1045
  • Fax:
Mailing address:
  • Phone: 215-925-2400
  • Fax: 215-925-9162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC014763
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPC014763
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerLICENSED PROFESSIONAL COUNSELOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: