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General NPI Number Information
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NPI Number | 1033303300
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Entity Type | Individual
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Provider Name | KELLY ANN LLEWELLYN LCPC
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Gender | Female
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 08/30/2007
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Provider Practice Location Address
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Address Line | 4832 MAIN ST
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-3613
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Country | US
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Telephone | 630-724-0246
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Fax |
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Provider Business Mailing Address
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Address Line | 6006 W.159 ST. BUILDING C
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City | OAK FORREST
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State | IL
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Zip | 60452
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Country | US
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Telephone | 708-535-7320
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | IL
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