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General NPI Number Information
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NPI Number | 1174905111
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Entity Type | Organization
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Legal Business Name | KELLIE L. VALENTINE LPC LLC
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 06/26/2015
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Provider Practice Location Address
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Address Line | 208 E BAYFRONT PKWY SUITE 200
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City | ERIE
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State | PA
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Zip | 16507-2414
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Country | US
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Telephone | 814-871-6333
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Fax | 814-871-6335
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Provider Business Mailing Address
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Address Line | 208 E BAYFRONT PKWY SUITE 200
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City | ERIE
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State | PA
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Zip | 16507-2414
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Country | US
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Telephone | 814-871-6333
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Fax | 814-871-6335
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | MS. KELLIE LEE VALENTINE
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Credential | LPC
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Telephone | 814-871-6333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC003467
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License Number State | PA
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